Article written by Diamond Braces Clinical Staff
Article medically reviewed by Dr. Oleg Drut
Usually not. In New York and New Jersey, Medicaid pays for orthodontic treatment only for patients under 21 who have a severe bite problem that the program considers medically necessary, and the treatment it covers is usually metal braces, not Invisalign. Adults 21 and older generally can't get orthodontic treatment through Medicaid in either state. If you have private dental insurance with an orthodontic benefit, it may pay part of the cost: Invisalign says insurance may help cover up to $3,000.
Why Medicaid Rarely Pays for Invisalign
Medicaid's orthodontic benefit exists to correct bite problems that affect health and function, such as trouble chewing or teeth that damage the gums. It is not meant to pay for straighter teeth for appearance, or for a more discreet way to straighten them. When a case qualifies, Medicaid pays for the treatment it considers necessary, which is usually metal braces. That is why a child can be approved for braces through Medicaid and still not have Invisalign covered.
New York: Medicaid and Child Health Plus
- New York Medicaid covers orthodontic care for patients under 21 who have a severe, physically handicapping malocclusion (bite problem). 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.
- Child Health Plus, New York's CHIP for children under 19, covers braces when they are medically necessary. Treatment must begin before the 19th birthday.
- Approval comes first. The orthodontist examines your child, documents the bite problem and asks the plan for approval before treatment starts.
New Jersey: NJ FamilyCare
NJ FamilyCare covers comprehensive orthodontic treatment for children under 21 with a handicapping malocclusion, under N.J.A.C. 10:56-2.15. The orthodontist scores the bite on the state's assessment tool, the HLD (NJ-Mod3). According to the state Medicaid office (DMAHS), a total score of 26 or more, or one of the conditions listed on the tool that qualify on their own, lets the request go forward. Below 26, the request needs documentation of functional problems or a medical condition.
Can Adults Get Invisalign With Medicaid?
Almost never. Federal rules require state Medicaid programs to cover dental care for people under 21, as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, but there are no minimum requirements for adult dental coverage, according to the U.S. Department of Health and Human Services. New York and New Jersey both limit Medicaid orthodontic treatment to patients under 21, so adults usually pay for Invisalign themselves or with private insurance.
If Medicaid Approves Braces, Can Your Child Get Invisalign Instead?
Ask before treatment starts. The approval is for the treatment the plan covers, which is usually metal braces. If you would rather have Invisalign, ask the office what your plan allows and what you would pay out of pocket, and get the answer before your child's treatment begins. Our office can also tell you whether it participates in your Medicaid plan. For more on what Medicaid covers, see getting braces with Medicaid and free and low-cost braces.
Other Ways to Pay for Invisalign
- Private dental insurance. Many plans with an orthodontic benefit treat Invisalign the same way as braces, up to a lifetime orthodontic maximum, typically $1,000 to $3,000. See insurance plans for Invisalign in New York and New Jersey.
- 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 orthodontic treatment. Confirm the rules with your plan administrator.
- Payment plans. Flexible payment plans are available at Diamond Braces. Monthly payments vary based on treatment cost, insurance benefits, down payment and payment term.
- A simple case. Ask whether your case can be treated as a simple case, which has a lower fee and a shorter plan.
What Invisalign Costs at Diamond Braces
These are the fees listed on our pricing page:
- Smilify, Invisalign treatment for simple cases (up to 12 months): $4,400
- Invisalign for complex cases (up to 24 months): $6,000
- Braces for the same types of case: $3,200 (up to 12 months) and $4,800 (up to 24 months), so Invisalign costs $1,200 more at each level.
Insurance is accepted on these treatment plans. Your final fee may depend on the complexity of your case, the estimated length of treatment, your insurance benefits, current promotions and your final treatment plan. Your exact fee is confirmed after your orthodontic evaluation. See our pricing conditions and how much Invisalign costs.
FAQ
Does Medicaid pay for Invisalign for teens?
Rarely. Teens under 21 in New York and New Jersey can get orthodontic treatment through Medicaid when their bite problem is severe enough to qualify, but the covered treatment is usually metal braces.
Will Medicaid cover Invisalign if it's medically necessary?
Medicaid decides whether orthodontic treatment is medically necessary, not which appliance you prefer. Even when a case qualifies, Invisalign coverage is rare. Ask the office what your plan allows before treatment starts.
Does Medicaid cover Invisalign for adults?
Almost never. New York and New Jersey limit Medicaid orthodontic treatment to patients under 21.
Does Medicaid cover braces?
For children and teens under 21 with a qualifying bite problem, yes. Learn more about getting braces with Medicaid and how much braces cost for kids.
Not sure what your plan covers? Find the office nearest you to book an evaluation, and ask us to check your Medicaid or insurance benefits.
Sources
- U.S. Department of Health and Human Services. Does Medicaid cover dental care?
- New York Codes, Rules and Regulations, 18 NYCRR 506.4, Orthodontic care.
- New York State of Health. Child Health Plus.
- New Jersey Administrative Code, N.J.A.C. 10:56-2.15, Orthodontic services.
- New Jersey Division of Medical Assistance and Health Services. Updated Criteria for Orthodontic Services and HLD (NJ-Mod3), Newsletter Vol. 32, No. 2, January 2022.
- Invisalign (Align Technology). Does insurance cover Invisalign aligners?
- Internal Revenue Service. Publication 502, Medical and Dental Expenses.
