Article written by Diamond Braces Clinical Staff
Article medically reviewed by Dr. Oleg Drut
In New York, Child Health Plus (the state's CHIP) and Medicaid cover braces for teens when the treatment is medically necessary, with prior approval and before an age cutoff: the 19th birthday for Child Health Plus and the 21st for Medicaid. In New Jersey, NJ FamilyCare covers braces for children under 21 with a handicapping bite problem. Many employer and Marketplace dental plans also pay part of the cost of braces for teens, usually up to a lifetime maximum. None of these programs pays for braces done only for looks.
Insurance That Can Cover Braces for Teens
- Child Health Plus (CHIP). New York's health insurance for children under 19 who don't qualify for Medicaid. It covers braces when they are medically necessary.
- Medicaid. In New York, Medicaid covers orthodontic care for patients under 21 with a severe, physically handicapping malocclusion (bite problem). This includes Medicaid managed care plans.
- NJ FamilyCare. New Jersey's Medicaid and CHIP program covers braces for children under 21 who meet the state's medical criteria.
- Employer dental plans. Many include an orthodontic benefit for children and teens, often with an age limit and a lifetime maximum.
- Marketplace plans. Dental coverage for children under 19 is an essential health benefit under the Affordable Care Act, but braces are generally covered only when they are medically necessary.
Does Child Health Plus (CHIP) Cover Braces?
Yes, when braces are medically necessary. The New York State Department of Health lists dental care, including medically necessary orthodontia, among Child Health Plus benefits. Plans offer orthodontic services for a severe, physically handicapping malocclusion, and prior approval is required.
- Age cutoff. Treatment must be approved and the braces placed before your teen's 19th birthday.
- Cost. Child Health Plus has no copays. Depending on your family's income, you may pay a monthly premium for the coverage.
- Who can enroll. Child Health Plus is for children under 19 who don't qualify for Medicaid. New York City notes it is available regardless of income or immigration status.
Does Healthfirst Cover Braces?
Healthfirst sells several kinds of plans in New York, so the answer depends on which one your teen has:
- Healthfirst Child Health Plus: covers dental care, including braces when they are medically necessary.
- Healthfirst Medicaid plans: follow New York's Medicaid rule for orthodontics (medically necessary, under 21, prior approval).
- Healthfirst Leaf (Marketplace) plans: check the plan's dental benefits. Marketplace dental coverage for children generally includes braces only when they are medically necessary.
The same applies to other Child Health Plus and Medicaid plans, such as Fidelis Care, MetroPlusHealth or EmblemHealth: the state sets the rule, and your plan's member handbook lists the steps.
Medicaid and NJ FamilyCare Rules for Teen Braces
- New York Medicaid covers orthodontic care for patients under 21 who have a severe, physically handicapping malocclusion. Treatment must begin before the 21st birthday, and coverage runs up to three years of active treatment plus one year of retention, under state regulation 18 NYCRR 506.4.
- NJ FamilyCare covers orthodontic treatment for children under 21 with a handicapping malocclusion. The orthodontist measures the bite with a standard scoring index (HLD NJ-Mod3), and a child generally needs a score of 26 or more, under N.J.A.C. 10:56-2.15.
- Other states, including Pennsylvania and Connecticut, set their own rules.
Medicaid coverage generally means metal braces; it rarely covers Invisalign. Learn more about getting braces with Medicaid.
What "Medically Necessary" Means for Braces
Public programs pay for braces that fix a bite problem that affects health, not crooked teeth that only bother your teen's appearance. The orthodontist examines your teen, takes records and sends them to the plan for prior approval. For a Child Health Plus orthodontic review, that typically means a cephalometric X-ray, a panoramic X-ray, five to seven photos of the inside of the mouth and a standard review form. The plan decides whether your teen qualifies.
If the plan says no, your teen can still get braces as a private patient, and an employer dental plan may pay part of the cost.
Employer and Marketplace Dental Plans
- Age limit. A plan may cover braces for children but not for adults. Check the age by which treatment has to start.
- Lifetime maximum. Many plans apply a lifetime maximum to orthodontic treatment: a set amount per person, paid over the course of treatment.
- Waiting periods. Some plans make you wait before they pay for braces.
- Marketplace plans. Dental coverage for children is an essential health benefit, but braces are generally covered only when medically necessary, and even then a plan doesn't have to pay the full cost.
- Two plans. If both parents have dental coverage, the plans can sometimes coordinate benefits.
- FSA and HSA. IRS Publication 502 lists braces as dental treatment you can count as a medical expense, so flexible spending and health savings accounts can generally be used for the part insurance doesn't pay.
How to Check Your Teen's Coverage Before Treatment
- Find the plan name and member ID on your teen's insurance card.
- Ask the plan whether orthodontic treatment is covered, the age cutoff, the lifetime maximum and any waiting period.
- For Child Health Plus or Medicaid, ask what the plan needs for prior approval.
- Book an orthodontic evaluation and ask the office to check your teen's benefits before treatment starts.
- Watch the calendar: start before the cutoff birthday for your teen's program or plan.
See the insurance information and state-sponsored dental insurance pages.
What Braces Cost at Diamond Braces
Our pricing page lists braces at $3,200 for simple cases treated in up to 12 months and $4,800 for complex cases treated in up to 24 months. Ceramic braces add a $500 upgrade fee, and Invisalign adds $1,200 over braces. Insurance is accepted on these treatment plans. Your final fee may depend on the complexity of the case, the estimated length of treatment, the appliance you choose, your insurance benefits, current promotions and the final treatment plan, and it is confirmed after the orthodontic evaluation. Flexible payment plans are available. Monthly payments vary based on treatment cost, insurance benefits, down payment and payment term. For more detail, see how much braces cost for kids.
FAQ
Will CHIP insurance pay for braces?
Yes, if the braces are medically necessary and the plan approves them first. In New York, Child Health Plus requires the braces to be placed before your teen's 19th birthday.
Does insurance cover braces for a 14-year-old?
Often, yes. A 14-year-old is within the age limits of Child Health Plus, Medicaid and most dental plans that cover children. Public programs require a medical need, and private plans pay up to their orthodontic maximum.
What kind of insurance will cover braces?
Child Health Plus, Medicaid and NJ FamilyCare cover braces that are medically necessary. Employer dental plans with an orthodontic benefit and Marketplace plans with children's dental coverage can also pay part of the cost.
Can I get braces for free if I'm 17?
Possibly. If you have Child Health Plus or Medicaid and your bite problem qualifies as medically necessary, the program pays for the braces. With Child Health Plus, treatment must be approved and the braces placed before you turn 19; with New York Medicaid, treatment must start before you turn 21. Read more about free and low-cost braces.
Not sure what your teen's plan covers? Find the office nearest you to book an evaluation, and ask us to check your insurance benefits.
Sources
- New York State Department of Health. Child Health Plus: What benefits can you get for your children?
- Healthfirst. Child Health Plus plan.
- EmblemHealth. Child Health Plus dental benefit summary.
- CDPHP. Child Health Plus benefit updates: expanded orthodontic services.
- Optum Dental. Standard New York Child Health Plus Orthodontic Review Form.
- NYC 311. Child Health Plus.
- New York Codes, Rules and Regulations, 18 NYCRR 506.4, Orthodontic care.
- New Jersey Administrative Code, N.J.A.C. 10:56-2.15, Orthodontic services.
- HealthInsurance.org. Is pediatric dental coverage included in exchange plans?
- MetroPlusHealth. Dental coverage for children.
- Cigna Healthcare. What dental insurance covers orthodontics?
- Internal Revenue Service. Publication 502, Medical and Dental Expenses.
