When it comes to your overall health and well-being, it’s important that you take care of your dental health and get both regular checkups and preventative maintenance done. However, this can be difficult for those without any dental insurance.
According to the American Dental Association, among children ages 2-18, 38.7% have dental benefits through Medicaid or other government programs, and 11% of them had Medicaid, but no dental insurance. Among adults ages 19-64, only 6.7% percent have Medicaid with dental benefits, and 35.2% of them had Medicaid, but no dental insurance.
Dental insurance can get very expensive, especially if you want any comprehensive benefits included. Fortunately, there are programs such as Medicaid that can help you get low-cost health and dental insurance, depending on the state you live in.
What is Medicaid?
Medicaid is a free or low-cost health insurance program that is funded by both the state and the government. The coverage is provided for low-income families and any individual in need, including children, disabled and elderly people.
In thirty-two states, Medicaid is provided to anyone that is eligible to receive Supplemental Security Income (SSI) benefits. However, the financial eligibility requirements are not all the same in each state.
Does Medicaid Cover the Cost of Dental Care?
Each state has different qualifications and requirements that must be met for dental care to be covered by Medicaid. You will need to do some research to find out what the specific requirements are for your state.
About less than half the states will provide comprehensive dental benefits. On the other hand, in thirty-two states, Medicaid will cover dental care for certain categories, such as emergency dental services and medically necessary dental work.
Emergency Dental Services
Emergency dental services would consist of any necessary dental procedure or extraction that would provide immediate pain relief to a suffering person. This would also include any services needed to control bleeding or get rid of any infections, and any emergency treatment needed for an injury to the teeth or gums.
In the following eighteen states, Medicaid will only cover emergency dental services and no other dental care:
- New Hampshire
- West Virginia
Medically Necessary Dental Work
Since Medicaid is technically a primary health insurance program, it will include some procedures necessary for medical health. Some of the work included would be certain diseases, treatments required in correlation with other medical services covered in the program, and work required to fix non-biting injuries.
Currently, Medicaid will cover dental care when it is medically necessary for all 50 states. However, the state will be the one to determine if the procedure is a medical necessity.
Children and Individuals Under 21
For individuals under the age of 21, most dental services are required to be provided by Medicaid. Medicaid has a comprehensive benefit for children called the EPSDT which stands for Early and Periodic Screening, Diagnostic and Treatment program.This program is a mandatory service that all Medicaid states need to provide.
As part of this program, individuals need to have dental services done at specific time periods to meet common dental practice standards. The services in the EPSDT must provide a minimum of pain relief, elimination of infections, and restoration and maintenance of teeth.
Adults Over 21
For adults over the age of 21, Medicaid will at least cover emergency and medically necessary dental work needed in almost all states. Sometimes Medicaid in specific states will opt to provide coverage in certain situations such as disabled adults who can’t provide for themselves, pregnant women, and low-income seniors.
However, there is no minimum requirement that Medicaid needs to meet for adult dental coverage.
States That Will Provide Comprehensive Dental Coverage
There are thirty-two states that will provide some comprehensive benefits such as preventative care, restorative and periodontal work. The specific types and services covered may vary from state to state.
How to Use Medicaid for Dental Costs
With all the requirements that must be met to receive Medicaid, and all the specific qualifications needed to qualify for dental care, it can be a tedious process to get your dental costs covered. Follow these steps to make the process much smoother and easier.
Apply for a Medicaid Health Insurance Program
You should apply for Medicaid even if you don't think you'll qualify. Each state has several different options for coverage that could work for you. If you do get approved, there is no waiting period. Your coverage will start immediately after enrollment.
You can apply through either the health insurance marketplace or directly through your state's Medicaid agency.
When you fill out an application through the marketplace, you can apply for multiple different coverage plans based on your income. By doing it this way, sometimes you'll be approved for plans that are more affordable than you'd expect.
Then if you meet the requirements for Medicaid, someone from your state agency will contact you.
To apply directly with your state's Medicaid agency, do some research to find where they're located and either apply online or in person.
Keep in mind, when you go to apply you may need the following:
- Proof of identity
- Proof of citizenship
- Proof of income
- Proof of residence
- Proof of disability if applicable
Talk to Your State Medicaid Agency
Once you have been enrolled in Medicaid, you need to know what your dental options are. As we mentioned before, each state has different dental care services that they will provide.
Schedule an appointment to meet with your Medicaid agency and discuss your options. Keep note of any questions you have. Once you meet with your Medicaid agency, write down important pieces of information you'll need such as specific services, procedures, dental providers, and definitions.
Schedule An Appointment With a Dentist
Now that you know what dental services your Medicaid will cover, you need to find out what work you should have done. If your Medicaid agency has certain dental providers they require you to go through, then find one closest to you.
Schedule a visit to see a dentist and get an extensive oral examination done. Have the dentist write up any recommendations and requirements needed to care for your dental health. If there are any services or procedures that the dentist deems an emergency or medical necessity, make sure that it is noted with a clear explanation.
Compare Your Dentist's Recommendations to Your Medicaid Coverage
Now that you've had a dental exam done and you know which procedures or dental work you need, you can compare it to your Medicaid coverage. Depending on your state's dental coverage, you may find that they won't cover anything, or they'll only cover some services.
Some procedures may be more covered than others and require an additional out of pocket fee. In this case, you'll have to decide what options will be best for your dental health and what services you can afford.
Keep in mind that if your Medicaid doesn’t cover any of the services, there are financing options you can set up, so you don’t have to pay all at once.
Give the Bill to Medicaid
After you have made sure that Medicaid will cover the dental work you need, then schedule to have it done. Once you go back to your dental provider and get all the dental services or procedures done, you need to either mail the bill to Medicaid or bring it into your local Medicaid agency.
Follow up with your Medicaid agency to make sure they received the bill and continue following up until it gets paid.
So, to answer the question, does Medicaid cover dental care? Yes, it does for certain circumstances. Medicaid is a healthcare program that is co-funded by both the government and the state. Medicaid was created to provide insurance to low-income individuals and those in need. However, the overall healthcare and dental services covered are decided upon by the state.
For anyone under the age of twenty-one, dental care is required to be provided by Medicaid. This would cover any preventative or prescreening care, diagnostics, and treatments.
Eighteen states will only cover emergency or medically necessary dental services, while the other thirty-two will include some more comprehensive work such as preventative, restorative or periodontal care.
To get your dental costs covered you need first to apply and get qualified for Medicaid. Then you need to talk to your state’s local Medicaid agency to find out exactly what dental services they will cover. After you do all that, you will need to meet with a qualified dentist to get an exam, and then get all the work done, and send the bill to your Medicaid.