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Does Medicare Cover Orthodontic Care?

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By Daniel Petkevich
Nov 18, 2022

The answer might depend on your plan

More Medicare beneficiaries are seeking orthodontic care or braces later in life. If you are in a situation where orthodontic care is determined to be medically necessary, you can expect to get coverage through Medicare Parts A & B. However, usually Medicare will not cover orthodontic care for cosmetic purposes unless you have a Medicare Advantage plan with that extra benefit.

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Let's dig deeper into what orthodontic care can mean for an elderly population.

What is orthodontic care?

Orthodontic care is a treatment that helps to straighten, align and space teeth. This type of care includes braces, retainers and other devices used to reposition teeth. Orthodontic care can help alleviate pain caused by crooked or misaligned teeth while also helping you achieve a better smile.
Some people might think that orthodontic care is something only for adolescents, but many seniors are increasingly opting for orthodontic care as they age. It can help restore a youthful appearance and improve dental health.

Does Medicare cover orthodontic care?

It is important to note that Medicare Part A will only cover orthodontic care when it’s a secondary treatment following an accident, trauma, or illness. If you need orthodontic care and are looking to have Medicare cover it, you will need to see your dentist first. They will be the ones to determine whether or not your treatment is medically necessary. If they decide that it is, they can then fill out a request form for Medicare Part B coverage. For example, if you were in an accident and needed dental care to repair the damage done to your teeth and jaw, Medicare Part A may cover the cost of braces for the purposes of restoring function.
Medicare Part B covers orthodontic care when it is determined to be medically necessary, such as correcting misaligned teeth that interfere with eating or talking. In this case, the cost of your braces will likely be covered by Medicare Part B. Typically, you will be responsible for your Part B Deductible and 20% coinsurance for the remainder of the cost. Your plan may also cover that 20% if you are on a Medicare Supplement plan.

How Medicare Advantage can cover orthodontic care

If you have a Medicare Advantage plan, you may have coverage for orthodontic care. Many of these plans include extra benefits that can help cover costs associated with orthodontic treatments, such as braces and retainers. Check your plan to see what coverage is offered and make sure to ask your provider about any additional out-of-pocket costs you may need to pay.
While Medicare Advantage is an enticing option for beneficiaries who are interested in orthodontic care, keep in mind that the added benefits of Medicare Advantage might come at the expense of your core health benefits. A Medicare Supplement Plan G offers the most comprehensive coverage but without the dental perks. If you have questions about how to weigh the pros and cons of Medicare Supplement and Medicare Advantage, talk with one of our Medicare experts.

Alternatives to getting Medicare to cover orthodontic care

If your orthodontic care is not determined to be medically necessary, or if you have a traditional Medicare plan that doesn’t cover the cost of braces, there are other options available. You may want to consider applying for dental insurance through a private insurer. Some of these policies offer coverage for orthodontic treatments and can be a more affordable option than going through Medicare.
Keep in mind that age restrictions may apply, and you might have to pay out-of-pocket costs depending on the plan. You should also check with your dentist or orthodontist to see if they offer any payment plans or discounts for seniors.

Conclusion

When it comes to orthodontic care, Medicare only offers coverage in specific circumstances. However, Medicare Advantage can be a great resource for seniors who need this type of treatment. With the right coverage and provider, you can get access to quality treatment and help improve your dental health. Be sure to speak with your dentist and check your plan details before beginning treatment.
If you have any questions about Medicare coverage for orthodontic care, don't hesitate to reach out to our team of insurance experts today! We are happy to answer your questions and help you find the plan that is best for your needs. Give us a call at 1-888-376-2028 to discuss your Medicare options today.

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