Does Medicare Cover Braces?
Seniors may not be the population that comes to mind when we talk about braces, but many Medicare recipients are under the age of 65. If you are under 65 and qualify for Medicare due to disabilities, or if you’re over 65 and want or need braces, you may be wondering if Medicare will help cover your care.
According to AARP, over four million American adults wear braces, and some of these people are 65 and older. Braces aren’t necessarily just for straightening teeth either. Braces may be required to straighten out jaw problems or to aid in the cosmetic appeal of the teeth and mouth. If teeth are crowded and causing problems, braces may be prescribed in these situations as well. Some seniors may need to wear braces for a temporary period of time, but others may require braces for years.
How does Medicare cover the costs of braces?
Medicare benefits help pay for medically necessary inpatient and outpatient medical expenses, but unfortunately, Original Medicare coverage does not cover routine dental and orthodontic care, including braces.
Medicare provides coverage for some dental services related to medical care, including oral surgery. Due to this, it may be possible to receive coverage for braces if your doctor believes that braces are necessary to preserve your life or greatly improve your health. Always remember, however, that the key to receiving oral care services under Medicare is that the services must be medically necessary.
Medicare Part B for medically necessary dental care
If your dental services or braces are covered by Medicare benefits, they will generally be covered by Medicare Part B. This is outpatient insurance and is usually reserved to help pay for doctor visits and other outpatient care services. Medicare Part B pays for 80% of covered services, and Medicare recipients pay a 20% coinsurance.
Services covered by Medicare must be deemed medically necessary. Since Medicare does not provide a dental benefit, you will need to work with your doctor to document the medical need for braces in order to submit an appeal to the Centers for Medicare & Medicaid Services (CMS) once a claim is denied. This is the agency responsible for government oversight of the Medicare program.
Does Medicare Advantage cover braces?
Some seniors wonder whether Medicare Advantage plans cover braces since these types of plans often include extra coverage not found in Original Medicare. Since Medicare Advantage plans are offered by private insurers, many plans include dental benefits. To learn whether coverage for braces is available from a Medicare Advantage plan provider in your area, you’re encouraged to work with an independent Medicare insurance broker to explore your options and compare plans.