Medicaid also known as public aid or All kids program is a form of government assisted health care available to low-income families and individuals in Illinois that offers public assistance for children that are in need of dental care, including oral surgery, tooth extractions, and orthodontic treatment with braces but there are approximately only 2% orthodontist that accept Medicaid for braces in Illinois.
Who can qualify for braces covered by Medicaid in Illinois?
All Low income families in Illinois including Cook, Lake, DuPage and McHenry Counties as well as the surrounding communities of North Chicago, Lake Bluff, Lake Forest, Zion, Winthrop Harbor, Wadsworth, Lindenhurst, Gurnee, Round Lake Beach, Waukegan, Lake Villa, Grayslake, Antioch, Wauconda, Fox Lake, Vernon Hills and Round Lake can qualify for orthodontic treatment and braces on the All Kids program.
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Does Medicaid cover braces for adults in Illinois?
Orthodontic treatment with braces is available in the Medicaid health care program in Illinois, although not all children will be approved by the State of Illinois Medicaid administrators. The requirements for approval depend on various factors such as the level of income, the age of the patient, current oral health condition and the type of orthodontic treatment required. In general, children and individuals between the ages of 5 and 21 years can qualify for Medicaid in Illinois. State of Illinois Medicaid (Public Aid, Medical Card, Tarjeta Medica, All Kids) administrators are required to pre-approve all children looking for braces coverage even before orthodontic treatment can begin.
Orthodontic Experts, unlike many others, do not limit the number of patients accepted or the type of services offered to patients, and do their best to accept every patient with Medicaid Illinois medical card coverage.
What to do if my child is not covered under Medicaid braces Illinois program?
If you are considering orthodontic treatment with braces for your children, first you need to make sure to take your time to find the best Illinois Medicaid provider, and look for an orthodontist that takes Medicaid in Illinois for orthodontic treatment with braces. This is the key to achieving results that are entirely satisfying as compared to carrying a smile that your child might regret for years to come.
At Orthodontic Experts, we keep our fee as low as possible while providing quality services but if your application is turned down by the state, then we have other financially suitable options for our patients because we believe that finances should not deter you from making the right oral health decisions.
Eligibility Criteria
It is important to understand that Medicaid will only cover orthodontic braces for children under 21. Although, there are now some dental benefits for adults with Medicaid, but this does not extend to braces or orthodontics. So, if you are an adult with Medicaid and want braces, we can definitely assist you, but realize that your Medicaid insurance will not help with the costs.
However, Medicaid will pay for the costs of braces in full for children under 21, if they determine that the need for medically necessary braces exists. You can have your child be evaluated for this medical necessity once per year. If they get reviewed for braces and are denied, you can try again– but you must wait one year in between evaluations. Typically, they will allow three attempts. If they are denied before they have all their adult teeth, it may be a good idea, depending on your finances, to wait a year and try again. If they are denied after they have all their teeth, we typically cannot apply again, and it would likely be time to discuss private financing. (We offer a discount to these cases along with interest-free financing).
All orthodontic services require Prior authorization (PA) by the Wisconsin Medicaid. This PA will decide the reimbursement to the approved service.
Imagine the Possibilities, Even When Denied. Braces for Just $195/Month with No Down Payment
*Terms and Conditions apply. Must have state denial status or letter. An initial payment of $195 Is due on the day of placing braces, the rest of the payments will be completed via recurring monthly payments until the minimum amount has been remitted. Automatic deductions for the monthly payments must be set up. Metal braces only. Not applicable to patients with an active payment plan.
