Do you need orthodontic care but you don’t know if Medicare will cover it? This article looks at Invisalign treatment and whether your healthcare program will pay for you to have your teeth aligned. For those without healthcare benefits, the treatment can be costly.
Many people assume that Invisalign is considered a cosmetic procedure and as such, wouldn’t be covered by Medicare. You can find the facts below, although the answer is somewhat complicated.
What is Invisalign?
Invisalign is a dental treatment that falls under the scope of orthodontistry. The process involves fitting a transparent and discreet aligner that you wear to correct misalignment over time. The technology has been around for more than 20 years and it’s proved so popular in the United States that most people with misaligned teeth have either had the treatment or wished they could.
The device is a level up from traditional braces and offers manner advantages over the semi-permanent dental fixtures. The aligner can be removed while eating and maintaining hygiene, it’s almost invisible to the eye, and it’s comfortable to wear.
How do Medicaid and Medicare stand on Invisalign?
Firstly, let’s look at the difference between the US federal healthcare programs, Medicare and Medicaid, which have different eligibility criteria and target different sectors of the population.
Medicaid covers the low-income population. Benefits vary by state and coverage is assessed by income. Medicaid covers some things that Medicare doesn’t. However, it’s important to note that Medicaid does not cover Invisalign treatment and considers it a cosmetic treatment. However, you may be covered for braces if your condition is assessed as medically essential and it’s not for cosmetic reasons.
Medicare, on the other hand, is a bit more open with people’s coverage of Invisalign treatment, and some—although few—can qualify under certain conditions.
There’s another, different way to have medical costs covered, and that’s under federal policy that writes off people’s medical debt.
What is Medicare and how does it work?
Medicare mainly covers individuals aged 65 or older. Younger people who qualify for coverage are those with some form of disability. There are several parts to Medicare that cover different healthcare aspects:
- Medicare Part A – Hospital Insurance: These benefits cover hospital stays, nursing facility and hospice care, and some general healthcare needs.
- Medicare Part B – Medical Insurance: This is for doctors’ visits, medical supplies, preventative services, and outpatient care.
- MedicarePart C – Medicare Advantage: This is an alternative to standard Medicare benefits and provides coverage via Medicare-owned private insurance companies.
- Medicare Part D – Prescription Drug Coverage: This covers the costs of prescription medication.
Does Medicare cover Invisalign?
Most people would be correct in assuming that Medicare doesn’t cover Invisalign or any routine dental or orthodontic treatments. However, this is not entirely the case, and some will qualify under exceptions under Part C, or they have a Medigap option.
- Medicare Advantage plans: Certain Medicare Advantage plans (which fall under Part C) offer extra benefits beyond standard Medicare coverage. These plans may include dental needs, potentially covering Invisalign (or other orthodontic treatment). You need to study the specific details of the plan to determine eligibility for dental or orthodontic treatment.
- Medicare Supplement Insurance (Medigap): While Medigap plans help cover certain out-of-pocket costs associated with Medicare, they typically do not include dental care. However, some Medigap plans give you the option to add extra dental coverage, which could potentially cover Invisalign.
- Special circumstances: With motivation, Medicare may cover dental procedures if they are considered medically essential. But these cases are rare and conditions are generally severe.
In summary, you’re not going to be covered for Invisalign by Medicaid, and only be Medicare in extremely rare cases. A better option would be to investigate the cost of the treatment you need and set up a regular savings plan with a goal. You should also investigate the changes that are happening in Medicare in 2025.