Does Medicare Cover Braces?: Orthodontia And Insurance

Orthodontia is an illness of the teeth and jaw where a person’s bite is altered. Usually, orthodontics affects children at a young age, but in some cases, it also occurs with seniors’ teeth. You can get it treated by getting braces. However, the procedure for braces is quite expensive.

In such situations, a low-income senior might consider getting their braces removed for free or getting it covered under Medicare. But, does Medicare cover braces? The answer is yes and no. Read along to know why.

Does Medicare Cover Braces? 

Medicare is the insurance plan that covers medical expenses for seniors. It covers the cost of various medical expenses, but does Medicare cover braces? If the procedure is conducted for cosmetic purposes, Medicare will not fund it.

However, if you give the deciding jury a valid reason for going through the procedure, you can get it funded by this government insurance plan.

Types of Medicare Plans: Which One Is Helpful?

Not many of us know that the Medicare plan is divided into four parts – Medicare Plan A, B, C, and D. All these plans serve different purposes and cover varied medical bills altogether.

• Medicare Part A (Hospital Insurance): Covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
• Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.
• Medicare Part C (Medicare Advantage): These private insurance plans combine Part A and Part B benefits, often with additional coverage like prescription drugs (Medicare Advantage Prescription Drug plans or MAPD).
• Medicare Part D (Prescription Drug Coverage): Provides coverage for prescription medications and is available as a standalone or part of a Medicare Advantage plan.

You can gain benefits from all these plans for your braces installation procedure, but you must prove that the procedure is medically necessary. You can avail of the benefits if you have been in an accident or life-altering incident where your jaw has been disfigured or your bite has been affected.

Does Medicare Cover Invisalign?

Invisalign is a special kind of aligner that straightens your teeth invisibly. It is the best choice as an adult as it saves you from embarrassment and is easier to remove and reinstate between eating and cleaning. However, you need to get them changed every week, and the procedure, along with the cost of the braces, is pretty expensive. You might wonder, What can you eat with braces?

On top of it, the federal doesn’t consider the Invisalign treatment medically necessary, which means the Medicare Advantage plan would not cover the costs of the procedure either. However, you must consider consulting your plan representative to see if there is a possibility of getting Medicare to cover the costs in your case.

If the federal insurance plan doesn’t cover the costs, you still have an option of other insurance providers that can help you out. Some providers cover the costs of Invisalign treatments. However, these companies would not cover all the costs. If you are found eligible for the benefits they offer, even then, you’d have to pay 50% – 75% of the procedure charges from your pocket.

Procedure To Enroll And Avail Benefits Of The Medicare Advantage Plan

Medicare Advantage Plan can prove beneficial to older adults in more than one way. One must enroll in the plan at the correct time to avail of the benefits when required. The enrollment process is simple.

1. Being Eligible:
   • Determining your eligibility is the first thing you must do before turning 65 because seniors 65 years or above are directly eligible for the plan.
2. Reviewing the plan benefits and choosing the right one:
   • This is crucial because the “Does Medicare cover braces?” question pops into one’s mind.
   • The federal government backs the Original Medicare (Plan A and B), while private companies administer the Advantage Plan (Plan C).
   • Plan C often covers additional benefits like drug coverage.
3. Look for the Additional Prescription Drug Coverage:
   • If you opt for Original Medicare, you must also review Medicare Supplement Insurance Policy (Medigap).
   • It helps cover deductibles, copayments, and coinsurance that Original Medicare doesn’t pay. You’d have to buy it through private insurance companies.
4. Enrolling:
   • Usually, seniors are straightaway enrolled in the plan, but if you aren’t, you must complete the process 3 months before turning 65.
   • The Initial Enrollment Period begins 3 months before your 65th birthday and extends for 3 months after your birthday.

To ensure proper oral hygiene with braces, visit the Plan’s official website or call the Social Security Administration at 1-800-772-1213. You must also check the Medicare Plans, as their coverage change yearly. You can ring up the Medicare helpline or consult a licensed insurance provider for any query resolution regarding oral hygiene with braces.

The Bottom Line

Braces are essential for the alignment of your teeth and a better bite, but the procedure is quite expensive, excluding the cost of braces. For a senior, this procedure can be tough to follow through for financial reasons. However, you can get help through the plans under Medicare cover braces, and if they find the procedure medically necessary for you, you can pay for it through Medicare.

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