Braces with Hoosier Medicaid Plan
In the state of Indiana, each Medicaid program has different criteria for determining if a person or family qualifies for coverage. Eligibility for Medicaid is based on various factors including income, assets, family size, medical need, or a combination of these factors.
If you want to get Braces with Hoosier Medicaid Plan, first you need to know what Hoosier Healthwise is. Basically, it is a health care program for children up to age 19, pregnant women, and low-income parents/caretakers residents of the state of Indiana. Under Hoosier Healthwise Health care is provided at little or no-cost to Indiana families enrolled in the program. The Plan is sponsored by the state of Indiana and administered by the Indiana Family and Social Services Administration (FSSA). Hoosier Healthwise covers a variety of health needs such as prescription, doctor visits, mental health care, dental care, medicine, Therapies, Family planning services, Nurse practitioner services, Nurse midwife services, Lab and X-ray services, Chiropractors, hospitalizations, and surgeries at little or no-cost to the member or the member’s family.
The Children’s Health Insurance Program (CHIP) is a part of the Hoosier Healthwise program. It is for children up to age 19 whose families have slightly higher incomes. In the Children’s Health Insurance Program, members have to pay a low monthly premium for coverage as well as copays for certain services.
Services Covered with Hoosier
Medicaid Plan
Hoosier Healthwise covers two benefit packages
Hoosier Healthwise Package A
This is a full-service coverage plan for children and pregnant women. Members of Hoosier Healthwise Package A do not have any cost-sharing obligations.
Hoosier Healthwise Package C
This is a full-service coverage plan for children enrolled in the Children’s Health Insurance Program (CHIP). Members of Hoosier Healthwise have to pay a small monthly premium payment and co-pay for some services based on family income.
A patient can have either Anthem BC/BS or MDWISE which is administered by Dentaquest.
These two are the only plans that have Orthodontic services.
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Hoosier Program Requirements
In order to qualify for Hoosier Healthwise benefit program, you must be under 19 years of age or be a primary caregiver with a child under the age of 19, resident of the state of Indiana, not covered by health insurance, and a U.S. national, citizen, legal alien, or permanent resident.
In order to qualify, you must have an annual household income (before taxes) that is less than or equal to the following annual income $31,225 for an individual, $42,275 for 2 people, $64,375 for 4 family members and $108,575 for a family having 8 members. For a family with more than eight members, add $11,050 per additional person. You should always check with the appropriate managing agency to ensure the most accurate guidelines.
Criteria’s for Braces with Hoosier Medicaid Plan
Members meet the criteria for medical necessity for orthodontic care when it is part of a case involving treatment of craniofacial anomalies, malocclusion caused as the result of trauma, or a severe malocclusion or craniofacial disharmony that includes but not limited to:
- Overjet equal to or greater than 9 mm
- Reverse overjet equal to or greater than 3.5 mm
- Posterior crossbite with no functional occlusal contact
- Lateral or anterior open bite with either palatal trauma or mandibular anterior gingival trauma
- One or more impacted teeth with an eruption that is impeded (excluding third molars)
- Defects of cleft lip and palate or other craniofacial anomalies or trauma
- Congenitally missing teeth (extensive hypodontia) of at least one tooth per quadrant (excluding third molars)
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Procedures and Maximum Fees
Under Hoosier Healthwise Medicaid plan you can get orthodontic treatment of the following two categories:
Interceptive Orthodontic treatment (Phase I)
It is an extension of preventive orthodontic care that may include localized tooth movement. Interceptive orthodontic treatment can occur in the primary or transitional dentition and it includes procedures such as correction of dental crossbite, recovery of space loss where overall space is inadequate. By initiating interceptive orthodontics in the incipient stages of a developing problem, it may reduce the severity of the malformation and mitigate its cause. The maximum cost of Interceptive orthodontic treatment is $1650 under Hoosier Healthwise.
Comprehensive Orthodontic Treatment (Bonding)
It includes a coordinated diagnosis and treatment aiming the improvement of craniofacial dysfunction and/or dentofacial deformity of a patient which may include anatomical, functional and/or aesthetic relationships. Comprehensive Orthodontic Treatment may utilize fixed and/or removable orthodontic appliances such as Braces and Clear aligners. It may incorporate treatment phases focusing on specific objectives at various stages of dentofacial development.
