Orthodontic procedures that help align teeth or correct a person’s bite are often performed at a young age, but there may be many circumstances that arise for older adults that require this kind of care. Medicare recipients should have a comprehensive understanding of how their benefits work and what kind of coverage may be available to them for orthodontic care.

Evaluating Need for Orthodontic Care

Treating irregularities with your teeth or your jaw fall under a branch of dentistry called orthodontia. Orthodontists, the dental professionals who perform these procedures, are specialists who can evaluate your needs and inform you of the work that can be done.

Your general dentist may refer you to an orthodontist when they identify any abnormalities or if you will undergo other procedures that require orthodontic care as part of the treatment plan. This may occur if you need reconstructive jaw surgery following a fracture or the removal of a facial tumor.

The position of your teeth and your bite can change naturally over time, which can then complicate how you chew food or maintain your oral hygiene. Uneven spacing or an improper bite increase the risk of wearing down tooth enamel, which leaves you more vulnerable to breakage and decay.

Different Types of Braces

Braces work by slowly realigning teeth into positions that create even spacing and a proper bite. If you wore braces at a young age, it’s possible you may need them again as an adult. However, there may be more options available to you now as an adult than would have been possible as a child.

These are the most common types of braces for adults:

  • Conventional. These braces work by affixing metal or ceramic brackets to each tooth so that they can hold a wire and bands that helps realign your teeth and reposition your bite.
  • Self-ligating. Though these braces look and function much like conventional ones, no bands are required as part of the adjustment process due to the clip-style brackets allowing the wire itself to be tightened, instead.
  • Lingual. Fixed to the back of the teeth rather than the front, these braces function like conventional ones but remain virtually unseen due to their positioning.
  • Aligners. Customized, clear trays gradually realign the position of your teeth through stages that require a new set of trays every few weeks.

Once braces are removed, you may be required to wear a retainer for a certain amount of time each day to complete the treatment process.

Medicare Coverage for Orthodontic Care

Generally speaking, Medicare recipients who are seeking braces or other orthodontic care will not have these procedures covered by Part A or Part B Medicare benefits. However, if an accident or disease requires a restorative orthodontic procedure, it’s possible that it will be considered medically necessary to warrant coverage through Original Medicare.

In the event of an emergency or surgical orthodontic procedure that requires a hospital stay, Medicare Part A may cover the associated hospital costs even if the costs related directly to the orthodontic procedure aren’t covered.

Although Original Medicare Part A and Part B limit the circumstances in which they offer recipients coverage for orthodontic care, you may be able to find expanded dental benefits through a Medicare Advantage Plan. The plans provide everything that Original Medicare offers, but they also typically include additional benefits like vision and dental care.

Because Medicare Advantage Plans are offered by private insurance companies, the packages available through these plans differ. Even though they may offer coverage for routine dental care, this may not include specialist care like braces or other orthodontic care. Check the list of benefits provided by each insurer to understand your options and any related cost-sharing like co-payments, deductibles and limits.

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