Across the country, it seems like orthodontic treatment has never been more popular. According to the American Association of Orthodontics, just under 4 million pediatric patients are currently undergoing orthodontic treatment, as are millions of adults. And it’s easy to see why.
After undergoing orthodontic treatment like Invisalign and conventional fixed braces, patients regularly report:
- A boost in personal appearance
- Higher confidence and self-esteem
- Better oral health
Given these benefits, it’s no wonder that more people than ever are seeking out orthodontic work. However, many potential patients are unsure of whether their insurance plan will cover treatment. Here at Beverly Hills Orthodontics, some of the most common coverage questions involve the California Medical Assistance Program, better known as Medi-Cal.
Designed to provide comprehensive coverage to low- and no-income Californians, Medi-Cal currently provides coverage to more than 13 million people. As a comprehensive healthcare program, Medi-Cal is multifaceted and covers necessities such as personal care physician appointments, dental work, and hospitalizations. But what about orthodontics?
As with other insurance options, Medi-Cal users don’t always know exactly what is and what isn’t by their plan. In the orthodontist’s office, this leads to questions:
- Does Medi-Cal cover orthodontics?
- Which orthodontic problems are covered by Medi-Cal?
- Who is eligible to receive orthodontic care under the Medi-Cal program?
We’ll help you find the answers.
Does Medi-Cal Cover Orthodontics? Yes! (With Limits)
Since 1965, Medi-Cal has provided Californians with a wide range of health services. Administered by the Department of Public Social Services, Medi-Cal’s benefits cover the following treatments:
- Personal care physician visits
- Dental appointments
- Preventative care
- Pregnancy care
- Prescription medicines
Beginning in February 1991, Medi-Cal expanded its dental program to include orthodontic care. However, there are very defined limits to what kind of care Medi-Cal will cover. Most importantly, Medi-Cal’s orthodontic program is restricted by both patient age and misalignment severity.
What Medi-Cal Orthodontics Can and Can’t Cover
While Medi-Cal does cover orthodontic work, not all treatments are covered by the program. Moreover, age restrictions make many Medi-Cal patients ineligible for orthodontic coverage.
As of 2022, Medi-Cal orthodontic coverage is only available to patients under the age of 21—no extensions allowed. For patients under 21, Medi-Cal coverage is only available for issues considered “medically necessary” according to Title 22 of the California Code of Regulations. To paraphrase the language from Title 22 §51340.1, Medi-Cal covers treatments that will:
- Relieve pain
- Prevent infection
- Restore teeth
- Aid in maintaining dental health
- Correct physical defects
In accordance with these terms, six conditions automatically qualify for coverage under Medi-Cal. These conditions include:
- Cleft palate deformities
- Craniofacial anomalies
- Deep overbites that cause lower incisor teeth to damage soft palate tissue
- Crossbites in which anterior teeth damage soft tissue
- Severe overjets greater than 9mm
- Severe traumatic deviation (e.g. bone/tissue loss caused by burns, physical trauma, etc.)
If you or your child have these conditions, schedule an appointment with our office and inquire about Medi-Cal coverage for your treatment.
Beverly Hills Orthodontics Is Your Home for Medi-Cal Covered Orthodontic Treatment
If you qualify for realignment work, “Does Medi-Cal cover orthodontics?” is likely just the beginning of your questions. Here at Beverly Hills Orthodontics, we’re here to answer all your questions and provide top-notch care for all of our patients.
As a VIP Diamond Plus Invisalign practice, Beverly Hills Orthodontics is recognized as one of the top Invisalign providers in the country. Our founder, Dr. Monica Madan, has been using both Invisalign and conventional braces to correct mild-to-severe orthodontic misalignments since BHO first opened its doors in 2008. From cleft palates to severe crossbites and overbites, Dr. Madan and the BHO team are available to treat Medi-Cal-covered issues and create healthy, beautiful smiles. Call today to learn more.