Does Medicaid cover Invisalign?
Unfortunately, Medicaid does not cover Invisalign treatment.
However, variations in guidelines and eligibility requirements exist among states, so it’s conceivable that certain states may make exceptions if the orthodontic treatment is deemed medically necessary.
Usually, Medicaid helps pay for braces for kids under a program called EPSDT. (Early and Periodic Screening, Diagnostic and Treatment )
But for adults, including Invisalign, coverage isn’t as common.
Some states may help pay for adult braces if your teeth are really bad. But not all states do.
You need to ask your state’s Medicaid program or your Medicaid plan to know if they cover Invisalign.
Image credits: iStock
What is Invisalign?
Invisalign is a clear aligner system that helps straighten teeth without the use of metal brackets and wires.
Unlike regular braces with metal pieces, Invisalign uses clear, removable plastic aligners that fit right over your teeth.
They’re custom-made to fit your mouth perfectly and gently push your teeth into the right places.
Why Doesn’t Medicaid Cover Invisalign Treatment?
Medicaid typically doesn’t cover Invisalign treatment due to several reasons:
1. Cost: Invisalign treatment’s higher expense makes it challenging for Medicaid programs to cover.
2. Prioritization: Medicaid prioritizes coverage for essential healthcare needs over elective procedures like orthodontic treatment.
3. Limited Resources: Medicaid programs have limited budgets, requiring allocation for a wide range of medical services.
4. Guidelines: Medicaid coverage guidelines may not include Invisalign or have strict criteria for coverage.
5. Benefit Structure: Each state determines Medicaid coverage based on its budget and priorities.
While some exceptions may apply, especially for children under the EPSDT benefit, Medicaid’s coverage for Invisalign varies significantly by state.
What are some rules you need to follow to get Medicaid coverage for Invisalign?
To qualify for Medicaid coverage for Invisalign, you must adhere to specific rules:
1. Meet Eligibility Criteria: Fulfill the requirements set by your state’s Medicaid program, including income and household size.
2. Obtain Prior Authorization: Before commencing Invisalign treatment, your dentist must seek approval from Medicaid by submitting a treatment plan.
3. Demonstrate Medical Necessity: Your dental provider needs to justify the need for Invisalign treatment.
4. Provide Documentation: Furnish dental records, X-rays, and diagnostic reports to support the need for Invisalign treatment.
5. Ensure Provider Participation: Choose a dentist or orthodontist who participates in the Medicaid program and is authorized to provide services.
6. Adhere to Follow-Up Care: Comply with specific follow-up care requirements, including attending regular check-ups and following the treatment plan.
7. Cover Cost Sharing: Be prepared for potential out-of-pocket expenses such as copayments or deductibles associated with Invisalign treatment.
Appealing Medicaid Claim Denials
If your Medicaid claim for Invisalign gets denied, you can appeal the decision.
Each state has its own appeal process, usually requiring additional documentation or evidence to support treatment necessity.
It’s advisable to consult your dental provider or contact your state’s Medicaid office for guidance on the appeals process.
Moreover, remember that Medicaid coverage can evolve, so staying informed about program updates is crucial.
If you’re contemplating Invisalign treatment and uncertain about Medicaid coverage, consider exploring alternative payment options or discussing affordable alternatives with your dental provider.
Non-Medicaid Invisalign funding
If you’re determined to get Invisalign treatment and Medicaid doesn’t cover it in your state, other funding options remain available, as long as they fit within your budget.
Non-Medicaid funding options for Invisalign treatment include:
- Dental loans.
- Savings plans.
- Dental tourism.
- Regular dental insurance.
Conclusion
It can be hard to get Medicaid to pay for Invisalign or other teeth-straightening treatments, but it’s possible in some places.
The important thing is; to know exactly what dental benefits your state’s Medicaid offers, to see a specialist who can confirm you really need the treatment, and to keep trying even if your claims get denied at first.
With the right plan, Medicaid can help you afford to fix your teeth and get the smile you want as an adult.
So, when your Invisalign treatment is finished, go ahead and show off your nice new smile!