Medicare and braces

Orthodontic procedures usually involve alignment of the teeth for cosmetic purposes or for the correction of the person’s bite. It may involve the use of braces that have to be worn for a prolonged duration. Most often, these procedures are performed at a younger age.

However, in some cases, even adults may require this kind of dental care.

If you or your family member is advised the use of braces, read further to check if Medicare covers the costs. Having a comprehensive understanding of how Medicare benefits work and the kind of coverage that might be available for orthodontic care will help you manage the expenses in a better way.

Will Medicare help cover braces?

Generally speaking, most orthodontic procedures are not covered by Medicare part A and B. Hence, Medicare recipients seeking braces or any other orthodontic care will not receive any benefits to cover the costs.

However, if the need for braces or the orthodontic procedure has occurred due to an accident, injury or disease, Medicare may offer coverage. The condition, in these cases, must require a restorative orthodontic procedure for the correction of the abnormality that has arisen strictly due to the accident, injury or disease.

Also, the patient would be eligible for Medicare coverage only if braces are considered medically necessary to prevent any complication or severe discomfort occurring due to the improper bite caused by the abnormality.

In the event of a surgical and emergency orthodontic procedure, which necessitates a hospital stay, the costs of the procedure would be covered by Medicare Part A. However, the coverage, in these cases, includes only the expenses related to the diagnostic procedures and the bed charges and doctors’ visits. It may not include the costs directly related to the orthodontic procedure or braces.

It should be noted that the Original Medicare Part A and Part B have certain limitations to the circumstances in which the recipient of braces or orthodontic care would be eligible for the coverage.

Hence, it is advisable to check whether any Medicare Advantage Plan offers expanded dental benefits. Most Medicare Advantage plans provide coverage for the expenses included in the Original Medicare Plan along with additional benefits such as braces and other dental and vision care.

However, since Medicare Advantage Plans are offered by private insurance companies, the benefits of each plan differ. Some Medicare Advantage Plans offer coverage only for routine dental care and may not cover specialist care such as braces.

Some Medicare Advantage Plans may offer extensive coverage that includes the costs of braces. Hence, it is advisable to check the list of benefits offered by the insurer to find out whether the plan includes coverage for braces or other treatments you plan to seek. You should also check the coverage and other cost-sharing options such as co-payments, limits, and deductibles.

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