Medicaid dental coverage is indeed an option, but the coverage you might actually receive depends on several factors. Some beneficiaries will receive fully covered and comprehensive dental care.
On the other hand, others might receive only specific coverage and might incur fees for some services. Most plans will offer basic coverage with at least partial compensation for larger procedures. Dental coverage in general, whether through a private plan or through Medicaid, varies greatly.
States have the flexibility to determine what Medicaid dental insurance will be provided to any adult Medicaid beneficiaries. Most states offer at least emergency dental services for adults, but fewer than half of the states currently provide comprehensive dental care. There are no mandatory benefits requirements for adult dental Medicaid coverage, so you must confirm with your state Medicaid agency regarding any potential dental care services you need while under Medicaid insurance.
Medicaid dental insurance is offered to certain beneficiaries under certain conditions. Any children younger than 21 years of age who receive Medicaid or CHIP (Children’s Health Insurance Program) benefits are fully entitled to comprehensive dental care. Adults 21 years of age or older who receive Medicaid benefits might receive dental care, depending on their state of residence and whether that state accepted the Medicaid expansion. Adult dental care is discretionary for all state Medicaid programs, even under the expansion of Medicaid.
Medicaid dental care services have increased as a result of the Affordable Care Act (also called the ACA or Obamacare) expansion of the program. However, even under those new rules and regulations, states can still choose individually whether to provide dental care coverage. You have to confirm with your state Medicaid agency as to whether or not you will receive any coverage and under what conditions.
Related Article: Medicaid Eligibility
Nearly all states do offer at least some partial Medicaid coverage for dental care services. Some will only provide emergency treatments, though, and many will charge high out-of-pocket costs or co-payments. Always check to see if you can receive preventative care and know which provider you could contact in case of a dental emergency.
Medicaid dental providers might offer a variety of covered services. These can be both preventative and emergency services. Remember that children younger than 21 years of age who are enrolled in Medicaid are eligible for comprehensive dental coverage. This should include the following services:
Medicaid and dental coverage for adults varies widely. If your state has expanded Medicaid, then your state Medicaid agency might offer adults the following dental benefits:
Generally, Medicaid dental coverage does not cover any cosmetic dental procedures like teeth whitening, cosmetic veneers or cosmetic implants and therefore must be paid in full out-of-pocket. Note that you might need a referral from your primary care physician (PCP) for certain Medicaid dental services. If you do, your primary health care provider will have to provide the authorization for you to receive those services, so contact your PCP first for assistance.
You can find a Medicaid dental provider for your children on the Insure Kids Now government website, where each state is required to offer a list of service providers.
Dental Medicaid coverage is a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) mandatory benefit. The dental services covered under Medicaid and CHIP for children younger than age 21 years old includes comprehensive preventative care. This means that oral examinations can and should be done at regular intervals and are fully covered by Medicaid.
Medicaid dental services are required to include pain relief and treatment of infections, tooth restoration and general dental health maintenance. That requires preventative and regular care, meaning that your Medicaid dental coverage for your kids cannot be limited to emergencies. The hope with this type of coverage is to ensure that children receive the right type of care and treatments early on, setting them up for better health as adults.
Additionally, if any problems are discovered during a regular oral examination, Medicaid dental coverage is extended to any treatment and services needed to address the issue. That applies even if your state’s Medicaid plan does not specifically list that treatment in its covered benefits section. Be sure to follow up with your state Medicaid agency if there is any problem with services or billing for your kids’ dental care.
For most types of Medicaid dental plans, standard dental services will usually be covered while specific dental procedures might only be partially covered or not covered at all. By covering preventative care and regular appointments, beneficiaries have a better chance of long-term oral health and fewer complications. Dental procedures can be very costly, so preventative care is always the preferred option for dental providers.
If your Medicaid dental plan offers coverage for preventative and diagnostic care, you should certainly take advantage and schedule your regular appointments. This type of care typically includes oral examinations, x-rays and cleanings. You might also receive partial coverage for other typical treatments like fillings, root canals or tooth extractions.
Your Medicaid dental coverage may or may not offer any assistance with major dental procedures, such as crowns or bridges. It is always good to confirm with your state Medicaid agency before scheduling any appointment for major work, since those costs might be high and you might reach a spending limit within your annual limits, if that is how your specific coverage operates. Always be sure to confirm first, rather than trying to cancel appointments or paying high costs out of your own pockets.
Related Article: Medicaid Costs and Coverage