How long does it take Medicaid to approve braces?
Asked by: Ms. Mable Runolfsdottir | Last update: July 22, 2025Score: 4.7/5 (35 votes)
How long does it take for medical to approve braces?
After the records have been submitted to Medi-Cal, it may take up to 1-6 months to receive an authorization or denial of treatment. If your child's case has been reviewed by Medi-cal and approved, we will call you to schedule him/her for placement of the braces (or other appliances).
How long does the waiting list for braces take?
The current waiting time for NHS braces is around two years. This means if your child is added to the waiting list when they are 16 or over, they run the risk of ageing out of eligibility. Waiting times can vary between areas, as some areas will have more NHS orthodontists offering treatment than in other areas.
How long does it take to get insurance approved for braces?
For private insurance, sometimes a Prior Authorization (PA) must be submitted before any dental/ortho work can be initiated, and that process can take weeks. For state sponsored plans, especially ortho, a state consultant must approve the case before any ortho treatment can be started.
Can you use Medicaid to get braces?
Federal rules for Medicaid programs dictate that orthodontic treatment for children must be covered if it is medically necessary. This guarantees that the most serious issues and those most likely to lead to additional problems in the long term are covered, but does leave significant room for variation between states.
Medicaid patients struggle to find orthodontic care
How to qualify for free braces?
How to Qualify for Free Braces for Kids. If your family has a low income, you may qualify for Medicaid, the Children's Health Insurance Plan (CHIP), or a state-sponsored low-income insurance program. These programs can provide free braces for your children.
What do braces fall under for insurance?
If you have dental insurance, most likely you have orthodontic benefits. Orthodontic benefits are separate from your normal dental insurance with your dentist. Orthodontic benefits are paid over the course of the treatment for the patient and normally have a lifetime maximum or co-pay per patient.
How long does it take for Medicaid to be approved for braces?
Once the necessary paperwork is completed and submitted to Medicaid, it is reviewed by a Claims Processor. The review process usually takes two weeks or less. Following the review, the orthodontic office will notify the family of the decision. Simultaneously, Medicaid will send the results by mail to the insured party.
Can I be denied braces?
In some cases, payers may also deny coverage because of the age of the patient. For example, if a patient is over the age of 18 and is seeking orthodontic treatment, many insurance plans will not cover the procedure as it is considered a cosmetic procedure.
How long is the process before getting braces?
How long after an orthodontist consultation do you get braces? Typically after the initial exam, it takes about 2-3 weeks to get your braces. Princeton Orthodontics is available for both the initial exam and the treatment. Dr.
How to speed up the waiting list for braces?
Choosing to Go Private
A primary reason parents opt for private dental care is so their child can receive their treatment immediately. Faster access to orthodontic treatment can reduce the risk of your child's teeth shifting further while on a waiting list.
Can you get braces twice for free?
Most dental insurance plans have a lifetime maximum for orthodontic treatment. If you've already hit that max with your first round of braces, you might be out of luck for round two.
Do you immediately get braces on your first appointment?
Most patients will have to wait until the second appointment to start achieving their better-than-ever smile. After all, the first check-in is designed to determine your tooth and gum health, get you in as a new patient, and meet your treatment coordinator and orthodontist.
How long does it take on the waiting list for braces?
Currently these waiting times may be in excess of 3 years.
In some circumstances you may be assessed as not eligible for treatment under the criteria – if you are not satisfied with this decision then, in the first instance you should discuss any further options with your referring dentist.
How long does a dental authorization take?
Keep in mind, pre-authorization can take time – between 5 and 30 days depending on the procedure being proposed and the dental insurance provider.
Can you get braces without dentist approval?
Almost never! Most dental insurance plans will not require patients to get a referral from their family dentist. During your first appointment, your orthodontist office should go over your treatment plan, financing options, payment plans, and maximizing your insurance benefits.
How much do braces cost with Medicaid?
In the event your orthodontic treatment is categorized as cosmetic, Medicaid does not cover braces. While the average cost for braces is $5,000-$6,000 out of pocket, there are other options for managing the expense, including: Dental insurance.
Can I get braces if I'm poor?
Not having insurance doesn't mean braces are out of reach. Here are a few options: Affordable dental clinics: Many clinics provide low-cost braces, offering options like payment plans that make treatment accessible even without insurance.
Who cannot get braces?
Oral health problems
If you have gum disease, missing teeth or periodontitis, it may not be advisable to have braces.
What to do if Medicaid denies braces?
But if you think that you are incorrectly denied, you can always first confirm the limits by your state, understand how medicaid actually counts your income and then you may at any time request a reversal. It is always best to discuss your case with a certified Medicaid planning professional.
How to get free braces with Medicaid?
Braces will only be covered by Medicaid if they're considered medically necessary. The requirements differ from state to state (see the next section). In general, though, braces are more likely to be considered necessary in cases of: Severe overbites, underbites, and other malocclusions.
Is there a waiting period for braces?
Yes, some dental insurance plans do have waiting periods before coverage for orthodontic treatment, including braces, becomes effective. Waiting periods can vary depending on the insurance provider and the specific plan you have.
How much do braces cost each month?
Monthly, it could be anything from $80 to $650. There are two main types of braces: metal and ceramic. Metal braces are the most common type, and they are also the most affordable option. Ceramic braces are more expensive, but they are less visible than metal braces.
How much does Medicare pay for braces?
Medicare does not cover dental care, including orthodontic treatments such as braces, unless medically necessary. If people require braces due to an injury, accident, or health condition, Medicare may cover the costs. If people have orthodontic treatment in the hospital, Medicare may also cover hospital-related costs.
How do you get braces if your insurance doesn't cover it?
If your current health insurance doesn't cover braces or only covers a small portion, you might want to explore other options. This could mean choosing a different plan from your current provider that has more coverage for orthodontics or looking into standalone dental insurance that may cover or help pay for braces.