Children Covered by the Medical Card
In some cases, a child who is covered by a Medical Card benefit might be eligible for braces. There are circumstances under which Medicaid, or state funded children's health insurance programs, pay for braces. Children under 18 years of age can be covered under the Medical Card. Some states have additional programs that will cover youths up to age 19 or even those who are under 21. Therefore, some young adults who have not yet reached the age of 21 might be eligible to receive coverage for braces. Generally speaking, children will only receive braces if they are deemed to be medically necessary.
More About Coverage
The extent of dental coverage provided by the Medical Card can be determined by each of the individual states. Most states provide for general care and preventative dental services for children on the Medical Card. These services usually include: check-up exams, cleaning and fillings for cavities. In some instances, braces are also an approved procedure. Braces will only be covered if they are shown to be medically necessary, rather than for cosmetic purposes. Children who have a severe overbite for instance, might be eligible to have braces paid for by their state's Medical Card. Kids who have jaw alignment problems or jaw and mouth deformities from birth, often are able to receive braces as part of their Medical Card coverage for dental care. If parent wants braces for their child, merely to improve the appearance of their child, the services will most likely not be approved. The same is true for a teenager who wants a straighter smile. Braces are typically not covered under the Medical Card, if a child simply has crooked teeth or a very minor overbite.
Adults
Most adults who have health insurance benefits through Medicaid and other state funded Medical Cards, cannot receive braces as part of their benefits. Dental benefits for adults are usually for emergency dental care. An example of such care is if someone has a dental infection. Some states and Medical Card providers do opt to offer annual cleaning and exams to Medical Card members. Basic treatment for cavities and related problems are sometimes covered as well. In most cases, braces will not be covered at all. In most instances, dental braces are considered to be a cosmetic procedure. If an adult has a severe dental problem that could lead to other dental or medical health risks, then braces might be covered. For instance, a severe overbite that results in speech problems or difficulty in eating some foods might be justified reasons to cover braces. If the Medical Card does cover braces for an adult, the determination is on a case to case basis.
Compared to Other Insurance
It is not unusual that the Medical Card only pays for braces in certain instances. Braces can be a very costly procedure. Most health insurance policies of any type will not cover braces. In fact, most general health insurances do not cover dental work, or only cover dental emergencies or severe dental infections. Generally speaking, an individual needs a separate dental insurance policy to pay for braces. These dental plans rarely, if ever, cover the entire cost of braces. Patients or parents of children who have braces will incur some out of pocket costs. Of course, an individual who is on the Medical Card can try to obtain dental insurance, or a dental discount program to help with the cost of braces and other non urgent dental care.
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