Can I Get Braces With Medical? Coverage Guide and Costs

Okay, let’s set the stage: You’re sitting there, maybe with your kid (or hey, maybe it’s you and your own teeth), scrolling through the internet and thinking, “Can I really get braces with my medical card, or is that just something people say?” Maybe you’ve heard, “Nah, insurance never covers stuff like that,” or someone at school or work said, “Don’t even bother, it’s way too expensive.”

If that’s you, first—deep breath. You’re not alone. This whole braces thing? It gets confusing, fast. Insurance, medical cards, Medicaid, rules that change depending on your age, where you live… it’s enough to make your head spin. But don’t worry: today, we’re breaking it all down, nice and easy, with all the real talk, numbers, and stories you wish someone had shared with you before.

Let’s clear up the myths, cut through the jargon, and figure out if you (or your kid) can get braces with medical. Ready? Let’s dig in together.

How Medical Insurance and Braces Actually Work (Not Just the Rumors!)

First off, let’s talk about what “medical” actually means here. A lot of people mix up medical insurance with dental insurance, and honestly, the paperwork doesn’t make it any easier! But here’s the lowdown:

• Medical insurance generally covers your, well, medical needs—think doctors, hospitals, emergencies.
• Dental insurance covers teeth, cleanings, fillings, and sometimes (but not always) braces.
• Medicaid and CHIP are government programs. They’re different depending on your state, but sometimes they cover braces if there’s a real medical need.

So when folks ask, “Can I get braces with medical?” what they usually mean is: Will my state insurance (like Medicaid or a medical card) pay for braces, or am I on my own?

Who Can Actually Get Braces With Medical? (And Who Can’t?)

This is where things get interesting. Because the answer is: It depends. (Yeah, I know, classic insurance answer. But stick with me!)

Let’s break it down. Most state insurance plans, including Medicaid, do cover braces—but only for kids and teens, and only when it’s “medically necessary.” That means:

• Severe bite problems (like you literally can’t chew your food properly).
• Problems that could cause bigger health issues down the road.
• Major misalignments, not just cosmetic stuff.

That’s why you’ll sometimes hear stories like, “My cousin got free braces in Illinois,” but someone in another state was told “no.” It all comes down to the rules where you live, and how bad the dental issue is.

What About Adults? Does Medicaid Pay for Braces for Adults?

Here’s the tough part: In most states, Medicaid does not cover braces for adults, unless it’s tied to a severe medical problem (like jaw surgery). I hear from a lot of adults who get their hopes up, only to get the classic insurance “denied” letter. I know, it’s frustrating—but I want you to have the facts so you can plan ahead. If you’re an adult, you’ll probably be looking at private dental insurance or out-of-pocket options.

Is 12 a Good Age to Get Braces? What About 10?

I get this question all the time, especially from parents. “My kid’s 10—should we start now? Or wait until 12?” Honestly, the right age for braces depends on your child’s mouth, not just a number. Some kids start as early as 10, others wait until they’re 12 or 13. The key is seeing an orthodontist early for an evaluation (and yes, that visit is often covered by Medicaid or state insurance). Sometimes early intervention can save you time, money, and hassle later on.

➤ Learn more about the age of braces Check out Is 12 a Good Age to Get Braces?.

The Step-By-Step: How to Get Braces With Medical (If You Qualify)

So, let’s say your kid has a real dental problem, and you’ve got a medical card or Medicaid. What next?

1. Get a referral. Usually, your dentist has to say, “Yep, this is serious,” and refer you to an orthodontist.
2. Go for a consultation. The orthodontist will check your (or your kid’s) teeth, take X-rays, maybe some photos, and fill out a special form for insurance.
3. Wait for approval. (Yeah, the hard part!) The insurance company decides if the case is “medically necessary.” Sometimes they say yes right away. Sometimes, you have to appeal. Don’t give up—if you think the need is real, fight for it!
4. If approved, you’re in! Braces get put on, and the journey begins.

If you’re in Illinois, for example, there are some orthodontists who work specifically with families on medical card plans, like Dr. Michael Stosich’s clinic. It can make the whole thing way less stressful.

Braces Cost: What Medical Covers (and What It Doesn’t)

Alright, let’s talk numbers. Because let’s be real: Braces are expensive. Like, “I could’ve bought a used car!” expensive. But how much do braces cost in different states, and what will your insurance actually pay?

State/City	Average Cost (No Insurance)	With Medical/Medicaid
Minnesota (MN)	$5,000 – $7,000	Usually covered for kids if medically necessary
New Jersey (NJ)	$5,500 – $7,500	Covered for qualifying children/teens
Hawaii	$6,000 – $8,000	Covered for severe cases, children only
Las Vegas, NV	$5,000 – $7,500	Sometimes covered, strict rules
Connecticut (CT)	$5,500 – $7,500	Covers children with severe needs
San Diego, CA	$6,000 – $8,000	Covered for qualifying minors
Massachusetts	$5,000 – $7,500	Covered for children, strict requirements
Iowa	$5,000 – $7,000	Covered for kids with medical necessity

So if you’re asking, “How much do braces cost in MN?” or “How much are braces in Hawaii?”—that’s the ballpark. And if you qualify under your state’s Medicaid/medical program, you could pay little or nothing out of pocket for your kid’s braces. For adults, though, expect to pay the full amount unless you have killer dental insurance.

Hidden Costs and Surprises: What Will I Still Pay?

Even if insurance covers your braces, there can be little surprises along the way. For example:

• Broken brackets: How much does a broken bracket cost? Usually $50–$100 per fix, but some clinics throw in a few repairs for free. Ask up front!
• Retainers: How much is a new retainer with insurance? Sometimes you get one retainer at the end of treatment, but extras can cost $200–$500. (And if your dog chews it? Yeah, you’re paying for that one.)
• Monthly payment for braces: If you don’t qualify for free coverage, a lot of orthodontists offer payment plans. Typical monthly payments for braces range from $100 to $250, depending on your down payment and total cost.

What Type of Braces Are Best For Teens (and What’s Covered)?

Let’s talk options. When you think “braces,” maybe you picture the classic metal smile, but there’s more out there:

• Traditional metal braces: The workhorse. Tough, reliable, and almost always covered if you qualify.
• Ceramic braces: Less visible, but sometimes not covered by insurance (and can cost more).
• Clear aligners (like Invisalign): Super popular, but Medicaid/medical usually won’t pay for these—unless there’s a special reason.

So, what are the best braces for teens? Honestly, it depends on your kid’s needs, your budget, and what insurance will allow. For most families using Medicaid or a medical card, traditional metal braces are the go-to. And hey, if you’re worried about your kid feeling self-conscious—remind them that almost everyone has braces at some point! Plus, you can always have fun with colored bands. (Pro tip: Neon green is a bold choice, ask me how I know!)

Real Stories: What It’s Like Getting Braces With Medical

Let’s make this real for a second. I remember a mom from Illinois who told me, “We’d never have been able to afford braces for my son if it wasn’t for the medical card. The process took a few months—lots of paperwork, calls, and waiting—but now he smiles with confidence. I’d do it all again in a heartbeat.”

But I’ve also heard stories from folks in states with stricter rules, who had to appeal decisions, send in extra X-rays, or even visit two or three orthodontists before getting approved. It’s not always smooth sailing, but if you’re persistent, you can absolutely get there.

And if you’re wondering, “What do braces for adults before and after look like?”—let me tell you, I’ve seen transformations that will make you believe in magic. (Well, dental magic, anyway.) Adults can and do get braces, and yes, it’s worth it if your smile is important to you. You just might have to work a little harder on the insurance front.

Expert Tips: Navigating the System Like a Pro

Alright, time for some rapid-fire advice—stuff I wish someone had told me before I dove into the braces maze:

• Document everything. Keep copies of referrals, letters, insurance approvals, and receipts. If something goes sideways, you’ll be glad you did.
• Be (politely) persistent. If your claim gets denied, appeal! Sometimes it’s just a missing form or unclear X-ray.
• Ask questions. Don’t be shy. “What will I have to pay for out of pocket?” “Are broken brackets included?” “How much are braces in NJ compared to here?” Your orthodontist’s office should know, and if not—they can find out.
• Get it in writing. If your coverage changes, get a confirmation letter. If someone at the insurance company says “it’s covered,” ask for their name and a copy of the policy.
• Connect with others. Join local Facebook groups, parenting forums, or ask friends who’ve been through it. Someone always has a tip or a warning!

Final Thoughts: You Deserve A Smile You Love (And Help Is Out There!)

So, after all this—can you get braces with medical? The answer is: Yes, if you (or your child) meet the criteria, and you’re willing to navigate the system. It’s not always easy, but it’s absolutely possible. And if you’re not sure where to start, reach out to a local orthodontist who works with Medicaid or your state’s medical card. Ask questions, advocate for yourself, and don’t let the jargon scare you off.

Remember: You’re not just a number on an insurance form. You’re a real person with a real story—and you deserve a healthy, confident smile. Don’t give up! If you’ve got your own story (good, bad, or somewhere in between), share it below. If you’re stuck in paperwork limbo, ask for help. We’re all in this together, and your experience could be the thing that helps someone else finally get the care they need.

So… what do you think? Did this clear things up? Ever been through the process yourself? Let’s swap stories, tips, and maybe even a few awkward braces photos. If you’ve got questions, drop them below—I’ll do my best to help. Here’s to your smile. You’ve got this!