Orthodontist Team of Chicago

A Leading Medicaid Orthodontist in Chicago

Orthodontic Experts has an established presence throughout Chicago and serves families across West Loop, Lakeview, Old Town, Bucktown, Avondale, Pilsen, and Kedzie.

Unlike many orthodontic offices that limit Medicaid acceptance, Orthodontic Experts works with Illinois Medicaid managed care plans and assists eligible families in completing the approval process properly.

Our orthodontists are experienced in evaluating cases under Illinois medical necessity guidelines and preparing documentation that aligns with state review standards.

When families search for a Chicago orthodontist that accepts Medicaid, they are typically looking for clarity, access, and guidance. Orthodontic Experts provides all three.

Schedule Now

Does Medicaid Cover Braces in Chicago?

If you are thinking of an orthodontist that takes Medicaid in Chicago, the key is understanding how Illinois approves orthodontic treatment: Medicaid coverage is tied to medical necessity and prior authorization not cosmetic alignment.

Illinois Medicaid (All Kids) may cover braces when orthodontic treatment is determined to be medically necessary and approved through prior authorization.

Approval depends on:

  • Clinical findings from a licensed orthodontist
  • Illinois HLD (Handicapping Labio-Lingual Deviation) scoring
  • Diagnostic documentation
  • Review by your Medicaid managed care organization

Coverage is not automatic. A professional orthodontic evaluation is required before any case can be submitted.

Schedule Now

Understanding Illinois Medicaid Orthodontic Coverage

Illinois Medicaid provides dental and orthodontic benefits to eligible children under the All Kids and Medical Assistance programs. The program is overseen by the Illinois Department of Healthcare and Family Services (HFS), and dental benefits are commonly administered through vendor and managed care networks (often including DentaQuest, depending on plan). Orthodontic treatment differs from routine dental services because it requires prior authorization and documented medical necessity.

Orthodontic Experts evaluates cases according to Illinois Medicaid guidelines. If eligibility appears likely, our team gathers diagnostic records and prepares a submission aligned with state requirements.

Orthodontic coverage in Illinois generally involves:

  • Orthodontic consultation and examination
  • Diagnostic X-rays and photographs
  • HLD scoring assessment
  • Submission to your Medicaid managed care organization
  • Formal approval before treatment begins

Illinois Medicaid orthodontic benefits are administered through managed care plans such as CountyCare, Molina Healthcare, IlliniCare Health, Blue Cross Community Health Plans, Aetna Better Health, YouthCare, and DCFS-related coverage.

For a complete breakdown of statewide eligibility rules, visit our detailed guide:

Illinois Medicaid Orthodontic Coverage Guide
Medicaid Insurance - Keeping America Healthy

How Orthodontic Experts Helps You Get Braces with Medicaid in Chicago

Step 01

No-Cost Orthodontic Consultation

At your Chicago Orthodontic Experts location, our orthodontist evaluates bite alignment, jaw development, eruption patterns, spacing, and overall orthodontic severity.

If the case may qualify under Illinois Medicaid medical necessity criteria, we proceed with diagnostic records.

Step 02

Diagnostic Records & HLD Evaluation

Our clinical team gathers:
  • Digital X-rays
  • Intraoral and facial photographs
  • Diagnostic models
  • Comprehensive treatment plan documentation

We calculate the HLD score and assess whether the case meets Illinois thresholds or qualifies under specific severe-condition criteria.

Step 03

Prior Authorization Submission

Orthodontic Experts prepares and submits the required documentation to your Medicaid managed care organization.

Each plan reviews submissions independently. Approval timelines vary, but decisions are often issued within several weeks. We notify families as soon as a determination is received.

Treatment begins only after official approval. (If a plan requires a referral or a specific in-network workflow, we will explain exactly what to do after reviewing your card.)

Step 04

High-Quality Care

If Medicaid does not cover treatment, we offer affordable payment options so you can still receive high-quality care.

What Qualifies as Medical Necessity Under Illinois Medicaid?

Illinois Medicaid uses the HLD scoring tool along with defined clinical criteria to determine whether braces are medically necessary.

Examples that may qualify include:
Young Girl with Braces

Age Criteria

Orthodontic treatment through Medicaid is typically available for patients under the age of 21 when it is considered medically necessary. Adults aged 21 and older may not be eligible for orthodontic benefits under their Medicaid or Medicare plan.

Schedule Now
Young Girl with Braces
Girl with Braces

Medical Necessity

Treatment must be required for functional or health-related reasons, such as:

  • Severe overjet (for example, 9mm or greater)
  • Deep impinging bite causing soft tissue trauma
  • Anterior crossbite with gingival recession
  • Cleft palate or craniofacial anomalies
  • Severe traumatic bite deviations
  • Impacted teeth with eruption interference
Schedule Now
Girl with Braces
Adult Woman with Braces

Low Gross Income

Medicaid is designed for low-income individuals and families based on Modified Adjusted Gross Income (MAGI).

Schedule Now
Adult Woman with Braces
Girl Smiling with Braces

Limitation For Treatments

Medicaid coverage for orthodontic treatment is generally limited to cases that are medically necessary and is typically approved only once per lifetime.

Schedule Now
Girl Smiling with Braces

Mild crowding or cosmetic alignment concerns typically do not meet Medicaid criteria.

Orthodontic Experts provides honest clinical evaluations and explains eligibility clearly before submission.

Illinois Medicaid Plans Accepted at Orthodontic Experts In Chicago

Families search using different terms, All Kids braces in Chicago, Public Aid braces Chicago, and medical card braces Chicago. These all generally refer to Illinois Medicaid coverage pathways. The fastest way to confirm your benefits is to bring your insurance card; our team will verify participation and next steps before any records or submission.

Orthodontic Experts works with many Illinois Medicaid managed care organizations, including:

Medicaid Logo Careington Logo
All Kids Logo Unum Logo
Illinicare Health Logo Colonial Life Logo
County Care Logo Always Care Logo
BlueCross BlueShield of Illinois Logo Cigna Logo
Molina Healthcare Logo UniCare Logo
Aetna Logo Delta Dental Logo

Participation may vary by location and policy. Our team verifies eligibility before moving forward.

If you are unsure which plan you have, bring your insurance card to your Orthodontic Experts consultation and we will review it with you.

  • Medicaid
  • Blue Cross Community
  • Aetna Better Health
  • YouthCare
  • AllKids
  • DCFS
  • Illinicare
  • Molina
  • CountyCare
  • Delta Dental PPO (all states)
  • BCBS
  • Unicare
  • Cigna
  • Aetna
  • Delta Dental
  • Careington
  • Unum
  • Starmount
  • Colonial Life
  • AlwaysCare
  • Guardian
  • Ameritas
  • Assurant Dental
  • SunLife Financial
  • Beam Dental
  • BCBS
  • Fort Dearborn Life
  • Dominion Dental
  • UHCL
  • Lincoln Financial
  • MetLife
  • Careington PPO
  • Metlife PPO
  • United HealthCare PPO
  • Unicare PPO
  • United Concordia PPO
  • Principal (includes Ameritas, Reliance)
  • Cigna PPO & Total Advantage PPO

What If Medicaid Denies Braces?

Orthodontic Experts understands that denial can be frustrating for families.

Common reasons may include:

  • HLD score below threshold
  • Documentation insufficient for review
  • Condition not classified as medically severe under plan criteria

If denied, we:

  • Review the explanation with you clearly
  • Determine whether additional documentation may help
  • Discuss possible appeal pathways when appropriate
  • Review flexible payment options if Medicaid coverage is unavailable

Our goal is to ensure families leave with clarity and informed next steps.

Schedule Now
Boy Wearing Braces

Chicago Orthodontic Experts Locations

Orthodontic Experts serves families throughout Chicago with seven neighborhood locations:

Orthodontic Experts Lakeview, Chicago

Orthodontic Experts Lakeview, Chicago

Visit Us
Orthodontic Experts Old Town, Chicago

Orthodontic Experts Old Town, Chicago

Visit Us
Orthodontic Experts Bucktown, Chicago

Orthodontic Experts Bucktown, Chicago

Visit Us

Families across Cook County choose Orthodontic Experts for Medicaid orthodontic evaluations because of accessibility, multiple Chicago locations, and experience with Illinois coverage standards.

Why Families Choose Orthodontic Experts for Medicaid Orthodontics in Chicago

Orthodontic Experts is recognized across Chicago for providing accessible orthodontic care and assisting families with Illinois Medicaid approvals.

Families choose Orthodontic Experts because we:

  • Have multiple established Chicago locations
  • Understand Illinois Medicaid orthodontic guidelines
  • Provide transparent explanation of eligibility criteria
  • Assist with prior authorization documentation
  • Offer no-cost consultations before commitment

Our approach combines clinical expertise with practical guidance.

Book a No-Cost Consultation

This field is for validation purposes and should be left unchanged.
First Name(Required)
Terms of Use(Required)

Clinical Oversight & Professional Review

This page is reviewed by licensed orthodontic providers affiliated with Orthodontic Experts. Clinical eligibility determinations are based on professional orthodontic examination and current Illinois Medicaid policies.

Information is reviewed periodically to reflect policy updates. Final coverage decisions are made by your Medicaid managed care organization.

A boy smiling with braces

Frequently Asked Questions

Does Orthodontic Experts accept Illinois Medicaid in Chicago?

Yes. Orthodontic Experts works with Illinois Medicaid and multiple managed care plans across its Chicago locations.

What is All Kids (Illinois) and is it the same as Medicaid?

All Kids is Illinois’ program that provides coverage for eligible children and is part of the broader Illinois Medicaid system. Your insurance card and plan name help determine the correct pathway.

What age qualifies for Medicaid orthodontic coverage in Illinois?

Orthodontic benefits are typically for children and teens, and eligibility is commonly evaluated for members under age 21. Final coverage depends on your plan and prior authorization review.

Will Medicaid automatically cover braces?

No. Approval depends on medical necessity and prior authorization review.

How long does Medicaid approval take?

Timelines vary by plan. Decisions are often issued within several weeks but are not guaranteed.

Do you need a referral for Medicaid braces in Chicago?

Some plans allow direct scheduling while others may require a referral. We confirm requirements after reviewing your card.

What should I bring to the consultation?

Bring your child’s insurance card, a parent/guardian photo ID, and any recent dental records if available. This helps us verify benefits and avoid delays.

Are retainers covered by Medicaid?

Coverage can vary by plan and by case. We will review what your plan includes after eligibility verification.

Can adults receive braces with Medicaid in Chicago?

Adult orthodontic coverage is limited under many Medicaid programs. Benefits can be reviewed during your consultation.

How do I schedule with Orthodontic Experts?

Call 855-720-2470 or request an appointment online to schedule your no-cost consultation.

Frenos Con Tarjeta Medica En Chicago – Orthodontic Experts

¿Busca un ortodoncista en Chicago que acepte Medicaid o All Kids?

Orthodontic Experts ofrece consulta sin costo y ayuda a las familias a verificar su cobertura y entender el proceso de aprobación cuando el tratamiento es médicamente necesario.

Llame hoy o programe su cita en línea.

Skip to content