Medicaid orthodontic program provides comprehensive dental coverage for their patients. Dental treatments may include treatment for pain and infections, teeth restoration treatments, and regular check-ups and cleanings. For orthodontics, however, very few patients requiring braces, or any other dental service will qualify for coverage unless their condition is deemed medically necessary.
Orthodontic Experts believe that everyone should have a right to smile perfectly and shouldn’t miss any opportunity of having a beautiful smile therefore we have got interest-free financing options with low monthly payments to make this dental treatment affordable for you. We also have many options for braces to meet your individual needs.
What is Medicaid?
Medicaid is basically a state-run and federally funded program that offers affordable health coverage to eligible adults, children, pregnant women, elderly adults, and people with disabilities. It’s an assistance program designed for healthcare to low-income families and individuals who may not be able to afford expensive healthcare treatments.
Are Braces covered by Wisconsin Medicaid?
The Medicaid approval process for dental care depends on various factors such as the age of the patient, current oral health condition, and the type of orthodontic treatment required. Medicaid covers dental care and orthodontic services, like braces, when they are deemed medically necessary for your child. Some examples include cases that consist of a cleft palate or severe anomalies of the face that can’t be adjusted without braces.
The first steps in finding out if you are qualified would be getting a referral from your primary dentist for an examination with an orthodontist, though it is not necessary and we would be more than happy to see you if you do not have a referral. The administrators of the State of Illinois Medicaid are required to pre-approve all children for braces coverage before orthodontic treatment can begin.
Additional pre-orthodontic services that can be covered include extractions and restorations, and these services would be provided by a dentist. We believe everyone should have the opportunity for a Dream Smile, so we are always available to help you navigate your coverage.
However, just because a patient may have moderate or severe orthodontic issues, and/or has been advised by a dental professional that they need braces, this does not mean that the patient will qualify for coverage.
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.
What are other plans available for Wisconsin Braces?
Orthodontic Experts perform orthodontic treatments if you have any of these plans available in Wisconsin Medicaid, iCare, Trilogy, and BadgerCare Plus.
What is a BadgerCare Plus dental program?
BadgerCare Plus is a similar program for groups of people who may not qualify for Medicaid or have different needs for healthcare coverage. BadgerCare Plus is also sometimes informally referred to as just BadgerCare. BadgerCare plus is a healthcare program for all low-income and disable residents of Wisconsin who are elderly, blind or disabled but still need healthcare coverage. It does not have an open enrollment period, and people can apply at any time.
Braces covered by Trilogy health insurance in Wisconsin
Trilogy is a healthcare insurance plan that is responsible for providing all medically necessary services under BadgerCare plus and Medicaid SSI. For Trilogy members in Wisconsin dental services are a covered benefit under BadgerCare Plus so typically you will get the braces covered. You may get covered dental services from a Medicaid-enrolled provider who will accept your Forward Health ID card. You may be charged a copayment for these services.
If you have a dental emergency, you have the right to obtain treatment within 24 hours of your request with any trilogy health insurance providers.
A dental emergency is a need for immediate dental services to treat severe dental pain, swelling, fever, infection, or injury to the teeth.