You will have a hard time getting Medicare to cover ceramic braces.
Medicare is a publicly funded medical insurance program in the United States, and, generally, it is only for people in their retirement years. While Medicare covers most medical procedures you want or need to undergo, you may find it difficult to get Medicare to cover ceramic braces for your teeth. If you are diligent, however, you may be able to convince Medicare to cover your orthodontics.
Identification
In general, Medicare regulations do not allow plan holders to use their policy to pay for any type of dental work, such as ceramic braces, reports the Center for Medicare Advocacy Inc. The wording in the Medicare policy code, however, indicates that there are special situations in which Medicare will cover dental procedures, as long as they are not "routine."
Function
In order to have Medicare pay for ceramic braces, you would need to prove to the administrators of the program that ceramic braces are a medical necessity, reports YourDentistryGuide.com. The situations in which Medicare pays for dental services generally coincide with other medical care, such as reconstructive jaw surgery after a car accident. You also must prove why you need ceramic braces rather than traditional metal orthodontics.
Expert Insight
Center for Medicare Advocacy advises people that getting Medicare to pay for ceramic braces might take quite awhile; you will likely need to appeal rejections for your claim up to the federal level, even if your doctor believes that the ceramics are a medical necessity. You are likely to win if you can show that the procedure is necessary and not routine. In 2005, a man was able to get the courts to agree that Medicare should pay for a video monitor for his eyes, even though Medicare considers eye care, like dental care, a routine procedure.
Tips
Center for Medicare Advocacy suggests that people who want to try to have Medicare cover ceramic braces should have their primary physician outline a treatment plan that includes adjusting the teeth with ceramic braces. In addition, your doctor and dentist should be prepared to show your medical necessity for ceramic braces in a court of law.
If Medicare Does Not Cover Braces
DocShop.com reports that ceramic braces almost always cost more than metal braces; expect to pay upward of $5,600 (in 2008) for them if Medicare refuses to cover them in its plan. YourDentistryGuide.com warns people that they will likely need to pay for items such as ceramic braces out of their pocket, or consider buying dental insurance (that covers orthodontics) or a dental plan.
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