If you’re considering Invisalign treatment and wondering if Medicare will help cover the cost, you’re not alone. Many people are curious about whether this popular orthodontic option is included in their Medicare benefits. Let’s break it down in simple terms so you can understand what’s covered and what’s not.
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What does Medicare Cover?
Medicare is a federal health insurance program primarily for people aged 65 and older. It’s divided into different parts, each covering specific medical services:
- Medicare Part A (Hospital Insurance):Â Covers hospital stays, skilled nursing care, hospice care, and some home health services.
- Medicare Part B (Medical Insurance):Â Covers doctor visits, outpatient care, lab tests, and preventive services.
When it comes to dental care, including orthodontic treatments like Invisalign, Medicare coverage is limited.
Does Medicare Part A & B Cover Invisalign?
Typically, Medicare Part A does not cover routine dental care or orthodontic treatments like Invisalign. However, there are exceptions. If you need orthodontic care as part of treatment for an accident, trauma, or illness, Medicare Part A might cover it. For example, if you’re in an accident that damages your teeth or jaw, Medicare could help pay for braces or Invisalign to restore function.
Even in these cases, Medicare Part B may need to be involved, and you’ll have to follow specific steps to request coverage.
When is Invisalign Considered Medically Necessary?
For Medicare to cover Invisalign, it must be deemed medically necessary. This means the treatment is required to address a functional issue, not just for cosmetic reasons.
Here’s how it works:
- Consult Your Dentist or Orthodontist: They’ll assess your condition and determine if Invisalign is necessary to restore proper function.
- Submit a Coverage Request:Â If your dentist decides Invisalign is medically necessary, they can submit a request to Medicare Part B.
- Medicare Review:Â Medicare will review the request to see if it meets their criteria for medical necessity.
Even if approved, Medicare Part B may only cover part of the cost, leaving you responsible for deductibles, copayments, or coinsurance.
What Are Your Options?
If Medicare doesn’t cover Invisalign, you still have options to help manage the cost:
- Medicare Advantage Plans (Part C): Some plans may offer additional dental benefits, including orthodontic care. Check with your provider to see what’s included.
- Supplemental Dental Insurance:Â Consider purchasing a separate dental plan that covers orthodontic treatments.
- Flexible Payment Plans:Â Many orthodontists offer payment plans to make Invisalign more affordable.
How the Mair Agency Can Help
Navigating Medicare can be tricky, but you don’t have to do it alone. The Mair Agency is here to help you understand your options and find the best plan for your needs.
- Learn the basics with their Medicare for Beginners guide.
- Watch their free video course to get a clear overview of Medicare.
- Attend a free Medicare seminar to ask questions and get expert advice.
If you’re in North Carolina and have questions about Medicare or dental coverage, contact the Mair Agency today for personalized guidance.
Take the Next Step
Understanding Medicare doesn’t have to be overwhelming. Visit the Mair Agency to explore your options, or reach out to their team for expert advice. Whether you’re curious about Invisalign or need help choosing the right plan, they’re here to make Medicare simple and stress-free.
Learn More About Coverage With Our Free Medicare Course
