How do you find an orthodontist who accepts Medicaid for braces close to home?
Many providers choose not to participate because the reimbursement rates are meager, and the program does not cover adults over 21 unless the braces are medically necessary.
Go to the provider directory of your Managed Care Organization to locate dentists that accept Medicaid for medically necessary treatment (adults, teenagers, and children)
Refer to the provider directory of your Dental Benefits Manager to identify dentists that accept Medicaid to treat handicapping malocclusion (children and teenagers only).
Meanwhile, searching by the state insurance name offers little help.
Orthodontists Accepting Medicaid for Adult Braces
Finding local orthodontists that accept Medicaid for braces for adults will prove enormously challenging because the publically-funded program rarely supports these benefits for recipients past their 21st birthday.
- Medicaid covers braces for adults only when medically necessary: prevent, diagnose, or treat an injury, disease, or symptoms.
- Free braces programs for low-income adults might prove a more viable avenue for the majority who do not meet these strict criteria.
These three examples illustrate how the least expensive treatment rule interacts with the need for a medically necessary reason.
Smile Direct Club is unlikely to take Medicaid for adults wanting their clear braces because the state insurance will not pay claims when treating recipients over 21.
Smile Direct Club is best suited for patients with mild to moderate alignment issues: crowding and gaps between teeth. Therefore, it would be an inappropriate solution for people with severe problems deemed medically necessary.
Local orthodontists recommending Invisalign are unlikely to take Medicaid for adults because the transparent braces system is not the least expensive treatment alternative.
Invisalign costs include in-person consultation with a doctor of your choice who takes the initial impressions and monitors progress. The higher level of care represents a pricier solution than competitors with mail-based business models.
Orthodontists affiliated with Smile Doctors are likelier to take Medicaid for adults because they offer the least expensive alternative for medically necessary services.
Smile Doctors treatments include metal and ceramic braces along with clear aligner systems. Only the metal braces satisfy both criteria: least expensive and suitable for medically necessary treatment.
Children’s Orthodontists Accepting Medicaid for Braces
Finding local orthodontists accepting Medicaid for children’s braces is much easier because the publically-funded program often supports these benefits for recipients before their 21st birthday.
Medicaid covers braces for children for two reasons reflecting its dual nature.
- The health insurance component addresses medically necessary reasons
- The dental insurance element pays to treat handicapping malocclusions
Insure Kids Now publishes a nationwide online provider directory that produces listings from the private companies contributing data. However, it is not comprehensive and might not be up to date. You may need to refer to the directory published by the organization noted on your member ID card.
Managed Care Organizations
The provider directory published by your Managed Care Organization (MCO) is the place to turn to when looking for a craniofacial orthodontist in your area that takes Medicaid to treat your child for a medically necessary congenital defect.
An MCO is a private third-party company specializing in healthcare claims administration. The medical insurance component addresses the advanced care your child needs. Correcting congenital issues requires a specialist.
Find the MCO name on your member ID card and search online to locate their provider directory. It could be any of these companies.
- Aetna Better Health: CA, FL, IL, KS, KY, LA, MD, MI, NJ, NY, OH, PA, TX, WV, VA
- Amerigroup: NJ
- Anthem: CA, IN, KY, NV, VA, WI
- Blue Cross Blue Shield: is a national federation of affiliated companies using this trade name, operating in twenty-four states
- Caresource: GA, IN, OH
- Emblemhealth: NY
- Fidelis: NY
- Healthfirst: NY
- Humana: FL, IL, KY
- Meridian: IL, IA, MI
- Metroplus: Five boroughs of NCY – Bronx, Brooklyn, Manhattan, Queens, and Staten Island
- Molina: CA, FL, ID, IL, KY, MI, MS, NM, NY, OH, SC, TX, UT, WA, WI
- MVP: NY, VT
- United Healthcare: Offers plans nationwide
- UPMC Health Plan: MD, OH, PA, WV
- Sunshine Health: FL
- Staywell: FL
- Wellcare: AZ, FL, GA, HI, KY, MO, NE, NJ, NY, SC
Dental Benefit Managers
The provider directory published by your Dental Benefits Manager (DBM) is the place to turn to when looking for a pediatric orthodontist who takes Medicaid to treat your child for a handicapping malocclusion.
A DBM is a private third-party company specializing in dental claims administration. Find the DBM name on your member ID card or MCO website, which could be one of these companies.
Finally, you are unlikely to find an orthodontist in your area who takes Medicaid by searching by a brand name. Many states concoct creative monikers for their programs, often confusing the people they serve.
Your task is to identify the MCO or DBM associated with your plan. See the two sections above if you found this article by searching one of these state-specific brand names.
|State||Brand 1||Brand 2|
|Colorado||Health First Colorado|
|Georgia||Peach State Health Plans|
|Illinois||Medical Card||County Care|
|Indiana||Hoosier Care||HIP Plus|
|Kentucky||Passport||KY Health Choices|
|Michigan||Medical Assistance||Healthy Michigan Plan|
|New Jersey||NJ Family Care|
|New York||Healthy Choice|
|North Carolina||Health Choice|
|Oregon||Oregon Health Plan|
|South Carolina||Healthy Connections|
|Virginia||Cover Virginia||Family Access to Medical Insurance Security|