Does Medicaid Cover Invisalign Braces?

Medicaid is supposed to serve as a health insurance safety net. It is government-provided health insurance for people who can’t afford insurance on their own. It’s available to low-income individuals and to families who meet certain eligibility requirements. Payments are made directly to health care providers and sometimes a small copay is required from the patient.

Though the program is funded by the federal government, it is administered a little differently by each state. This means that each state can set its own guidelines defining who is eligible and what services are provided. Many states also fund their own Medicaid programs for low-income individuals and families who do not meet the federal eligibility requirements. States that participate in the healthcare exchange created when the Affordable Care Act was passed also provides a hybrid program that helps people choose healthcare with the help of subsidies from the state and the federal government.

Invisalign braces are clear, removable braces that cover the teeth and keep them properly aligned. About every two weeks patients get a new set of Invisalign braces that are individually made to match the patient’s teeth. Invisalign first appeared on the market in 1999. More than 5 million people either have worn or are wearing Invisalign braces as of 2018. One million teens have used the product instead of metal braces.

While the cost of Invisalign treatment is similar to regular braces, it will still range from $3,500 to $5,000 in the United States, as of 2018. Some dental insurance plans will cover part of the costs as an orthodontic surgery. Other plans consider it cosmetic work, which means elective dental procedures, and so it isn’t covered.

Nearly all of the states will offer dental services as part of Medicaid, but what they cover and how much they cover differs. It is usually offered to children under 21 years old to prevent dental problems. For adults, it is mainly offered to relieve pain and infections and restore teeth. For the specific items covered in your state, you will need to contact your state Medicaid department.

Medicaid does not cover Invisalign treatment. Since there are some differences between state programs, it is possible that one state might make exceptions if the treatment is considered medically necessary. Check with your state's Medicaid program to see what options are available.