Medicaid provides healthcare services to low-income families in the U.S. – but does it cover dental? Medicaid dental coverage can be a bit confusing for families, which is why we’ve put together this guide about what Medicaid does and doesn’t cover when it comes to the dentist. As it turns out, Medicaid dental coverage varies greatly depending on your state of residence and whether you’re considered a vulnerable population.
Key points about adult Medicaid dental coverage
- Medicaid is a state-run program, which means dental coverage varies widely depending on your state. Dental coverage for your location may be none, emergency, limited or extensive.
- Every state has different coverage depending on your identity as well, i.e. children, pregnant women, the disabled or the elderly. For example, children are well-covered for preventative and emergency dental.
- Most but not all Medicaid programs provide emergency and medically necessary dental coverage. (Unfortunately, federal guidelines don’t demand dental coverage in Medicaid programs.)
- Not all dentists accept Medicaid as insurance. You’ll need to specifically seek out Medicaid-approved dentists.
- You’ll likely need a doctor’s referral and a prior authorization for certain types of dental procedures. Check with your dentist before undergoing any procedures.
State-based adult Medicaid dental coverage
Since Medicaid is a state-run program, every state defines its own level of coverage. This may vary among four different levels:
- None: In this case, Medicaid doesn’t cover any type of dental care for adults. (Three states don’t currently offer Medicaid dental coverage: Alabama, Delaware and Tennessee.)
- Emergency: Generally, emergency dental coverage involves procedures that would give immediate pain relief or resolve acute infection. This may include a tooth extraction, root canal, fillings and dentures.
- Limited: Limited dental services provide preventive and restorative care, such as cleanings, x-ray exams, crowns, cavity treatment, gum or tooth pain, or other non-urgent dental problems.
- Extensive: Extensive dental services typically allow up to a certain amount of maximum dental expenses of any kind (for example $1,500) and then any emergency coverage on top of that.
You’ll have to look up your state’s Medicaid dental coverage to know what type of dental coverage may be offered to adults. Here’s the 2019 Medicaid Dental Benefits by State listing, though you should go directly to your state’s site for the most up-to-date and accurate information.
Who is considered an adult for Medicaid dental coverage?
Individuals 21 and over are considered adults in Medicaid. Anyone under the age of 21 receives comprehensive child dental care under the EPSDT program, which stands for Early and Periodic Screening, Diagnostic and Treatment. Intended for children, this program includes a full-range of dental procedure coverage.
However, those 21 and over are considered adults, which means coverage may or may not be available. There’s no federal requirement for adult dental coverage, so it depends on the state. Coverage varies from none, emergency, limited and extensive.
I’m a low-income senior, do I have Medicaid dental coverage?
Some states offer special dental coverage for vulnerable populations besides children. This may include pregnant women, the disabled and the elderly. You should check with your specific state to see if they offer dental coverage for the elderly. Seniors with disabilities may also qualify for certain special coverage programs.
What if I have a dental emergency?
Most states offer emergency dental coverage for adults, but not all. Generally speaking, Medicaid covers medically necessary procedures. If you’re having a dental emergency, you should absolutely seek treatment. If considered medically necessary by your dentist, Medicaid will usually pay for it.
Is a check-up considered medically necessary dental work?
Unfortunately, a check-up isn’t typically considered medically necessary. Under the Medicaid definition, medically necessary involves certain diseases, mouth injuries and emergency procedures.
Check-ups are considered preventative care. Your state may cover preventative dental care, so be sure to check.
Do all dentists accept Medicaid?
Unfortunately, not all dentists accept Medicaid. That’s because dentists don’t typically receive much compensation from the Medicaid program. You should specifically look for Medicaid-approved dentists in order to get coverage.
What else should I know about going to the dentist with Medicaid dental coverage?
Going to the dentist isn’t usually a favorite activity. However, if you have Medicaid dental coverage, you can make your appointment go smoothly by:
- Making sure your dentist accepts Medicaid as insurance: Check this before setting up an appointment and confirm it at the reception when you arrive. This way, you can be sure that you won’t have out-of-pocket expenses.
- Getting a doctor’s referral for medically necessary care: If you believe you need medically necessary dental care, you may be required to have a doctor’s referral. In this case, you’ll need to go to your regular doctor before heading to the dentist.
- Getting prior authorization for certain types of dental procedures: Before undergoing any dental procedures, ask if you need prior authorization from Medicaid to get coverage. Your dentist should have information about whether you need prior authorization. This way, you won’t pick up the bill for a procedure that Medicaid would have covered.
How can I pay for the dentist if my state doesn’t have adult Medicaid dental coverage?
You may not live in a state that offers the dental coverage you need. If that’s the case, you should ask your dentist about financing options. You may be surprised to find that dentist offices offer payment plans so that you can get the procedure you need while squaring away the finances.
Does Medicaid cover dental? As you can see, it depends. You’ll need to check with your state Medicaid program to find out what type of dental coverage is offered for adults like you. Be sure to check if there is special coverage for the elderly or those with disabilities as well.