If your child needs orthodontic care and you have Medicaid, you’ll want to make sure you’re using your benefits as fully as possible. The first step to finding an orthodontist who accepts Medicaid in New York is to check your specific plan’s network. From there, you’ll still need to ensure your child meets coverage requirements under the state health insurance. If the plan approves treatment, Medicaid generally covers the essential orthodontic services included in the authorization.
The Orthodontists Associates of Western New York accepts a variety of Medicaid plans, as well as many of the most popular insurance plans in the area. We can confirm we’re within your network during a free consultation. We’ll also break down exactly what you’re approved for and whether there are any outstanding costs before you make any commitment.
1. Identify Providers in Your Specific Plan’s Network
First, you need to recognize that there are different kinds of Medicaid plans, including traditional Medicaid and Medicaid managed care plans.
With this in mind, you need to check that an orthodontist participates in your specific Medicaid plan. To check on your own, you can contact your plan provider by calling the number on the back of your insurance card.
Finding an in-network orthodontist is a critical step, but it’s only one part of accessing state benefits. You’ll still need your insurance provider to approve the plan.
2. Learn if Medicaid Will Approve Your Treatment
Just because an office accepts Medicaid doesn’t mean your braces or other treatments are automatically covered. You’ll still need to undergo an orthodontic evaluation that shows your issues are severe enough to meet the threshold.
In New York, orthodontic treatment is generally limited to patients under 21 with a severe, medically necessary malocclusion. New York’s coverage requires that the patient’s malocclusion meet documentation standards, including the Handicapping Labio-Lingual Deviation (HLD) Index report. Some cases are severe enough to meet the qualification threshold automatically, while others are defined by their severity score. Adults seeking orthodontics are much less likely to receive coverage, and it requires a narrower medical or surgical justification.
In order to be eligible for coverage, you’ll need to receive prior approval before active orthodontic treatment begins.
3. Understand How Coverage Applies
You also need to understand how coverage applies once you’re approved. You can generally expect coverage for the comprehensive treatment plan, not just a set dollar amount. That usually means the plan pays the orthodontist for services themselves. If you receive approval, coverage can include:
- Diagnostic imaging needed
- Braces placement or other orthodontic treatment
- Scheduled adjustments
- Retainers after treatment
State insurance doesn’t cover braces for reasons perceived to be purely cosmetic. It also won’t cover clear aligner treatment, categorizing it as elective.
Why Choose Us as Your Orthodontist Who Accepts Medicaid?
Wondering who to choose for your orthodontic treatment? The Orthodontists Associates of Western New York accepts Medicaid plans, and we’re more than happy to support you on the journey to a healthier bite.
We have 7 practices conveniently located across the region. Whether you’re based in Dunkirk, Niagara Falls, or East Aurora, we’ve got a location right near you. We accept many Medicaid plans, as well as some of the most popular insurance plans in the area. Patients trust us because we answer their questions with transparency and provide the highest level of care to every patient.
Moreover, we don’t charge for any visits until we start orthodontic treatment. So it costs you nothing to check your coverage and be fully sure of any remaining expenses. You can call our office and schedule an orthodontic evaluation, with no referral required.
Book a Free Consultation With an Orthodontist Who Accepts Medicaid Today
Finding an orthodontist who accepts Medicaid can feel challenging, especially when you have to take so many steps to double-check coverage. But the Orthodontists Associates of Western New York accepts Medicaid plans. When you still have remaining expenses, you can explore financing options at our office.
We believe that all patients should be able to afford a healthy, beautiful smile. We would love to help you figure out how to afford care. Book a free consultation.
