Does Medicaid Cover Dental? All Important Details You Need To Know

This article thoroughly explains all the dental procedures and services that Medicaid covers and provides all essential details about the Medicaid program.

The importance of dental health and well-being is undeniable and evident. Good dental health ensures and translates to the overall sound health of an individual. Oral hygiene is essential to prevent gum diseases and tooth decay. The negligence of dental health becomes the root cause of cavities and makes it hard and painful for people even to eat and speak.

Following an oral hygiene routine such as brushing and flossing is usually enough to keep dental problems away. However, avoiding a good hygiene routine results in the buildup of bacteria and germs. These germs can further induce many gum diseases and inflammations. The phrase that your mouth acts as a getaway to your health is true. Not caring for your oral health properly can lead to many other diseases, infections, and problems. So, to ensure a good way of living, it is crucial to understand the importance of dental care.

Some of the common oral problems that people face due to poor hygiene include yellowing teeth, bad breath, gum bleeding, plaque buildup, tooth loss, sensitivity, etc. These issues are bothersome and can easily make an extremely confident person lose his morale. On the other hand, good dental health promotes good overall health and boosts confidence. Good oral health only begins with proper cleaning habits and routines in our everyday lives.

Not everyone can end up sticking to good oral and dental care routines, and so they have to deal with dental problems too. But it is not wrong to say that dental procedures usually cost an arm and a leg. Since these procedures are so costly, people usually cannot afford them. On average, it can charge above 200$ for simple cleaning routines and examinations. And if, in any case, you have to get your cavities extracted, then it can cost several hundred dollars as well.

All in all, dental procedures are not affordable at all. So what should people do to avail of these services for their better health? Does Medicaid cover dental procedures?

What is Medicaid?

Medicaid is a federal public health insurance program that allows US citizens with a set income range and assets to avail medical care. This program either pays for all or some medical procedures and treatments. For instance, it pays for preventive therapies, emergency treatments, and even hospital care. This joint program is that the federal government and individual states fund and run for their citizens.

In short, it is a program that facilitates people with low income to get treatments at lower costs and sometimes at no cost at all. This service has provided for a lot of individuals all over the USA. Moreover, it has helped them get treated for multiple diseases and illnesses. The Medicaid program provides a wide range of treatments and medical procedures.

These include several doctor visits, medical transportation, X-rays and laboratory tests, freestanding birth centers, early and Periodic Screening, Diagnostic and Treatment Services (EPSDT), health center services meeting national qualifications, etc. These effective treatments and procedures allow people with low-income ranges to live a better and risk-free life.

Does Medicaid cover dental procedures and treatments?

Moreover, since it is a state-run program with the federal government’s involvement, the availability of these procedures varies from state to state. Dental treatment and care are some of the essential healthcare procedures. With age, people can get prone to many oral infections and problems. For the solution and further prevention of these issues, dental examinations and checkups are essential. So, does Medicaid cover dental too? The answer is yes, it does, but there are some limitations.

The Medicaid program covers a lot of medical treatments and procedures, but when it comes to dental care and treatments, the options are minimal. The Medicaid program provides some of the methods in some states and under certain conditions. Dental care includes various treatments and procedures for the mouth and teeth. So its span is quite vast. Medicaid provides all immediate dental procedures that fall under the emergency category. For instance, dental assistance after an injury. But, all other treatments are usually never paid for. The reason is that dental care has been marked optional by the federal Medicaid program.

This aspect limits the span of treatments and procedures that Medicaid provides. Although, every state has a different rule set that it follows since all states can independently choose the treatments they want to offer, the payments they will cover, and the eligibility criteria. So depending upon the treatments and payment coverage they provide, these states are categorized differently.

What dental procedures does Medicaid provide?

Some numerous dental treatments and procedures are present in the medical field. The span of dental coverage varies from state to state, with some that do not offer any dental practice. So, in which conditions does Medicaid cover dental? Generally, Medicaid covers treatments that prepare you for extensive medicine or even surgery, such as providing dentures to manage problems such as missing teeth, etc.

Mode of dental Coverage in Medicaid

Firstly, noting the states that do not provide any dental treatment should be highlighted. Based on the dental treatments they offer, the states have given four categories. These categories are:

  • None
  • Emergency
  • Limited
  • Extensive

The ‘none’ category includes the states that do not offer any dental procedures and benefits to their citizens. According to a recent study, the following states do not provide any dental treatment and insurance:

  • Alabama
  • Delaware
  • Maryland

These three states exclude any medical aid in the dental field. Their Medicaid programs focus on other treatments and do not offer their citizens and utilizer’s dental benefits. In such situations, people living in such states have to rely on their jobs for health insurance and help get their hands on such facilitating jobs. No aid is present for them, and they have to deal with their dental problems independently, as there is no other way.

States that provide extensive dental Medicaid to their citizens

On the brighter side, some states provide a lot of dental procedures and treatments as part of their Medicaid programs. These states are precisely 18 in number and are as follows:

  • California
  • Colorado
  • Connecticut
  • Montana
  • Ohio
  • Oregon
  • Rhode Island
  • Washington
  • Wisconsin
  • New Jersey
  • New Mexico
  • Idaho
  • Illinois
  • Iowa
  • Massachusetts
  • New York
  • North Carolina
  • North Dakota

These states offer Medicaid programs that provide extensive dental procedures and treatments to their citizens. Roughly benefits of around 1000$ to 1500$ are given annually. And these exclude all cosmetic procedures. So these are the states for which you do not have to ask anyone if/does Medicaid cover dental practices and services?

States that provide limited emergency dental procedures

According to a report, in Alaska, for instance, preventive dental procedures such as root canals, fillings, crowns, dentures, etc., fall under the umbrella of Medicaid dental facilities. And for these treatments, around 1,150$ are provided annually to people aged 21 and above. These services fall under the category of emergency treatments, and some of the states offer such treatments.

Other states that fall under this category are Arizona, Florida, Georgia, Hawaii, Maine, New Hampshire, etc. These limited emergency dental treatments generally cover all routine examinations to help detect a bigger problem. Moreover, these are far better than the states that do not allow any treatment.

Does Medicaid cover dental implants?

This question, although simple, cannot get a simple answer. Since the program differs from state to state, it has its terms and conditions everywhere. Does Medicaid cover dental implants for everyone? The procedures are termed cosmetic; Medicaid does not pay for them. Since this program is government-run, it indeed covers and provides aid to financially weak individuals. Dental implants are usually cosmetic, and thus, the Medicaid program does not cover such treatments, but there indeed are some exceptions. So, if you are someone who needs implants for another medically essential procedure, then you may find yourself eligible for this treatment.

The medical need for dental implants

Patients that can show a need for dental implants with their medical data may get approval. The first step is to get all necessary documents from your dentist that states an urgency for dental implants. In addition to this, you may also need a recommendation letter from your dentist to explain why dental implants are the only suitable treatment for your condition.

Moreover, you still will be required to get a thorough examination, and yet still, there will be enough chances of denial and rejection for your request. But trying never hurts. So, please give it a go and try your luck!

Patients under the age of 21

Individuals under the age of 21 can get dental implants after proving their undeniable need. According to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, these people can easily avail of funds as they are eligible.

So, people who are under 21 can easily claim such treatments. But people who are 21 or above cannot request such treatments as they cannot receive EPSDT funds and facilities.

Does Medicaid cover dental dentures in the dental services?

Many states do not provide such facilities, and some provide complete or partial assistance. But in this case, the recipient has to qualify first to get treatment.

For this purpose, meeting the eligibility criteria according to some of the guidelines part of this program is mandatory. Alaska, North Dakota, New York, Michigan, Idaho, etc., are some of the states that allow and pay for dentures. These include both partial and complete treatments that facilitate people greatly. For instance, in New York, even adults can get dentures, and New York Medicaid undertakes all their costs.

What does Medicaid cover generally in the health area?

The healthcare system has consistently proven highly burdensome to financially unstable people or has low-income rates. Thus, American citizens have access to government-run insurance programs to help divide their burden or ultimately end it to lift some of this burden. Through Medicaid, people have access to good health conditions and better living standards.

Put simply, families, pregnant women, people with disabilities, financially unstable individuals, and senior citizens can access all necessary health treatments, that too, whenever they need. In addition to providing mandatory medical coverage, there are some other facilities that people can avail themselves of with the help of the Medicaid program.

What does Medicaid pay for in the health field?

Medicaid is thus a program that pays for several healthcare methods and treatments. It covers various therapies and medical treatments. This is why many US citizens enroll themselves in this program and utilize all its health benefits. Families can also help from this initiative that the government has put forward for its public. Individuals such as children, adults, disabled people, etc., all have their own set of health that they can use. Following are some of the health areas that Medicaid covers and pays for:

Preventive treatments

As the name indicates, these treatments prevent long-term and chronic diseases from having better living standards and overall good health. Through Medicaid, people can access several preventive procedures and treatments for themselves and their families. Not only can individuals with low incomes have access to these treatments, but pregnant women and disabled individuals are also eligible.

These services include all types of immunizations that can prevent future sicknesses due to bacterial and viral infections. Secondly, all clinical and behavioral interventions also fall under the bracket of preventive services that the Medicaid program provides. Lastly, necessary training and counseling are also given to promote the better health of individuals. Moreover, first aid education is also a plus point for preventive services.

Alternative benefits plans (ABP’s)

These services are self-tailored by the state to provide treatments according to the individual needs of a specific region. Instead of providing health benefits through traditional ways, people can benefit from these programs on the basis of their regional requirements and particular systems. These plans are much more beneficial as their drawn results are also quick.

Major benefits

With the help of this program, many people have benefited a lot. These services can lay out better coverage in a regional space and reach out to people in need far better than the typical plan of Medicaid. Moreover, today, every person is more prone to diseases and illnesses. In such cases, senior citizens, pregnant women, disabled people, and needy individuals can better access health care measures and methods.

These alternative benefit plans (ABP’s) are far more applicable, and their outcome is also better than all of the other existing methods and techniques. Some of the significant benefits of ABP’s are:

  • States can make ABP coverage mandatory as part of the Medicaid plan for state-selected individuals.
  • The beneficiaries enrolled in this plan can get medically necessary ambulances and nonemergency medical transportation as part of their ABP service.
  • It also provides supplemental services to people who enroll in this plan.

These essential aspects help and encourage many individuals to register in this program and gain all the available benefits.

Autism

Since Autism is too common in the Us, providing its treatment in the Medicaid program is the most understandable. Hence, this program funds the treatment of Autism and provides all necessary services and treatments.

Four categories of treatment are given to people dealing with Autism. These include some behavioral and communication techniques, dietary therapies to ensure a good food intake, proper medications, and complementary or alternative medicine for further treatment.

Dental care plans

The dental plans for adults vary, but they are necessary for children under the age of 21. So all types of regular and routine checkups, examinations, and maintenance visits are part of this plan. Most states at least offer emergency dental coverage for adults under Medicaid. So there is no need to ask whether/does Medicaid cover dental procedures.

Behavioral health services (BHS)

This plan focuses on the mental well-being of individuals and covers all necessary treatments under the Medicaid program. By providing individuals with mental health facilities, any state can promote a mentally healthy population. This is why coverage of behavioral health services is also a crucial part of this program.

Screening and testing

Another vital service includes screening and testing. This varies for adults; however, every state provides some necessary procedures for children. These include the following essential tests:

  • Routine physical examination
  • Managing and completing a thorough medical history for the individual
  • Lab tests and procedures
  • Vision screening to check for eyesight
  • Regular dental checkups and exams
  • Hearing testing and services, etc.

All these services are part of the Medicaid program for adults as well as for children. With certain conditions and limitations for adults and people above the age of 21, this program mainly covers every essential routine health examination.

Can the dentists that take Medicaid also increase their patient count?

Yes! People love to avail themselves of services that they can and save money. In today’s time, where money is necessary for life, saving money is also essential. So, one way to save some money is to ensure you benefit the most from the Medicaid program. Since the services in the dental field are already limited, people try their best to gain such benefits. Thus, dentists operating in a specific state or region can benefit from such a situation.

By offering Medicaid, dentists can also increase their patient count and prove a very reliable source for their patients. The relationship between a doctor and a patient is usually trust-dependent. Hence, sticking to such values can also promote their work and help them grow in their respective health area.

In the case of Medicaid, many dentists within every state offer dental checkups and examinations. Dental practitioners can play a vital role in spreading awareness for such programs. Although easily accessible, the knowledge for such programs is not very commonplace. So evidently, dentists can actively promote such health insurance programs and benefit significantly from them individually.

Conclusion

As you can understand now, the Medicaid coverage entirely is the state’s decision. Some offer extensive health procedures and services, whereas others provide limited access to such treatment. Your age is also a crucial factor that decides if you are eligible for medical treatment or not. Individuals under the age of 21 have a lot of leverage over people 21 or more in age. Although Medicaid is available all over the USA, the services and provided treatments vary from state to state. This is the reason why states follow different sets of rules and regulations and introduce treatments accordingly.

When it comes to dental coverage, Medicaid does provide coverage, but it has a lot of certain limitations and specific factors for eligibility criteria. On the brighter side, every state has the authority to flexibly determine or decide as to which services it wants to provide. Oral health is highly crucial to all people. Not only does it contribute to overall health, but it can prevent a lot of other diseases as well. For instance, with age, certain infections in adults become more common. With less will to fight off bacterias and viruses, people are also prone to chronic diseases such as diabetes.

In this situation, poor oral health and hygiene can lead to further problems and diabetes progression as well. Furthermore, oral cancer, heart diseases, and many other illnesses quickly eat a person away. So not just to avoid these problems but to also ensure better overall individual health, states need to provide all necessary oral treatments and medical services to everyone and not just people under 21.

Till this happens, maintaining focus on improving oral care routines and habits can in many ways contribute to an overall healthier population. This is why the essentialness of having knowledge, understanding, and establishing standards for oral health needs to become common among all so that children can develop these beneficial habits of proper hygiene from an early age.

Tony Bennett

Tony Bennett

Tony Benett makes his living in the insurance industry by teaching and consulting. He is also recognized by the legal profession as an expert on insurance coverages. His insurance experience includes having worked at the company level, owned an independent general agency and having worked for an insurance association. He has received various certificates over the past few years and helps his clients and readers by giving them a realistic outlook on what they can expect to achieve within their set targets. At Insurance Noon, he is known for his in-depth analysis and attention to details with accuracy. He has been published as one of the most referred agents by his peers in the insurance community. Tony loves the outdoors and most sport events. His passion other than providing excellent advice is playing golf.