Dental Benefits For Adults In Medicaid
States have flexibility to determine what dental benefits are provided to adult Medicaid enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.
Does Medicaid Cover Dental
There is a common misconception that dental care and hygiene are less important than general health and medical needs. However, having a clean bill of dental health is a vital part of overall health and wellbeing.
This misconception of the importance of dental care has led healthcare programs, including Medicaid, to have a separation between general benefits and adult dental benefits. Instead of incorporating dental into the physical health coverage, it is added as a bonus or not at all.
If you have been wondering if your state of residences Medicaid program has dental benefits included, read on to find out what is available in your state. If you live in a place without Medicaid dental care, there are also resources included in this article to give you the tools to take care of all aspects of your health.
How Much Does A Knee Brace Cost
The cost of knee braces varies according to several factors. Some braces are relatively simple in design and dont cost very much, while others have to be customized to fit your leg and can come with a high price tag. In the United States, the typical cost of a knee brace from a major brand runs between $20-$30 for something simple to a few hundred dollars for a fitted device. Some knee braces are available off the shelf for less money than this, while specialized devices can cost up to several thousand dollars. Your Medicare benefits typically only cover the braces your doctor decides you need, and then only for the knee braces you get through a Medicare-approved supplier. Braces you buy off the shelf are not generally paid for by Medicare.
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Upcoming Expansion Of Medicaid Dental Coverage
Of the three states not providing any benefits for their general populations, two states, Tennessee and Maryland, are in the process of extending Medicaid dental benefits to their general populations.
Tennessee passed a budget this year that includes $25.5 million for adult dental benefits under Medicaid. Maryland also plans to provide limited dental benefits for its adult Medicaid population in January. This will leave Alabama as the only state not offering some form of dental coverage for adults enrolled in Medicaid.
In addition, New Hampshires Medicaid program, which currently only covers emergency dental care, will start providing extensive dental benefits on April 1.
Adult Access To Dental Care
Access to and use of dental care among low-income adults depends on a number of variables. Medicaid eligibility for low-income adults, Medicaid coverage of dental benefits, the availability of dental providers, and beneficiary and provider awareness of the importance of preventive dental care all bear on whether low-income adults obtain dental services. Particularly in the absence of dental benefits, cost is the main barrier to access to dental care for low-income adults.20 Paying for services out-of-pocket is difficult, if not impossible, on their strained budgets. Over time, persistent lack of access to dental care or connection with dental providers may result in low expectations for oral health among low-income adults, reinforcing existing disparities. And if consumers are unaware of the need for regular checkups or cannot afford them, they may wait until they experience oral pain to seek care.
Dental Care Utilization and Unmet Need
Figure 3: Percentage of Nonelderly Adults with a Dental Visit in the Past Year, by Income and Insurance Status, 2013
Figure 4: Unmet Need for Dental Care Due to Cost in Past 12 Months Among Full-Year Insured Nonelderly Adults, March 2015
Provider Availability and the Role of Health Centers
Expanding the Supply of Dental Care: Scope-of-Practice & New Provider Types
Dental Delivery System
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Medicaid Dental Benefits For Adults
States have considerable discretion in defining Medicaid adult dental benefits because these services are optional, not mandatory, under federal Medicaid law. Adult dental benefits are a state option across the board for adults who qualify for Medicaid under pre-ACA law and also for adults newly eligible for Medicaid under the ACA expansion. States must provide Alternative Benefit Plans for Medicaid expansion adults, modeled on one of four benchmark options specified in the law, including an option for coverage approved by the HHS Secretary. All ABPs must include the ten essential health benefits established by the ACA.13 Notably, the EHBs include pediatric dental benefits, but not adult dental benefits.14 Many states have used the Secretary-approved coverage option to conform the benefits they provide for expansion adults with their benefits for adults in traditional Medicaid, modifying them as necessary to comply with the EHB requirements. Of the 31 states and DC that have adopted the Medicaid expansion, all but two states provide the same dental benefits for expansion adults that they do for the traditional adult Medicaid population. The two exceptions are Montana and North Dakota. Montana provides limited dental benefits for its traditional Medicaid adult population, but none for Medicaid expansion adults North Dakota provides extensive dental benefits for traditional Medicaid adults, but none for expansion adults.
Dental Plans And Program
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. People on Medicaid will get services using one or more of these plan types:
Managed Medical Assistance : Provides Medicaid covered medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services. Most people on Medicaid will receive their care from a plan that covers MMA services.
Long-Term Care : Provides Medicaid LTC services like care in a nursing facility, assisted living, or at home. To get LTC you must be at least 18 years old and meet nursing home level of care .
Dental: Provides all Medicaid dental services for children and adults. All people on Medicaid must enroll in a dental plan.
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Which States Have No Adult Dental Coverage
Only a small number of states have no dental coverage whatsoever. If you live in the following states and need dental care, you will have to do so outside of Medicaid benefits.
States with no adult dental benefits:
If your state of residence is one of these four, then any dental care will not be covered by Medicaid. This can be very alarming to hear since out-of-pocket dental expenses can be incredibly high.
Resources For Those Without Dental Coverage
However, there are still ways to get affordable dental care without Medicaid. Here are some options that may be available to you:
- If you are 65 or older and are enrolled in a Medicare Part C program, there is a good chance that you have dental coverage through this program. Talk to a program coordinator and find out if you are covered.
- Find the nearest dental school. Every state has a university that includes a dental program. This is one of the most competitive programs to get into, so even a student dentist will be very capable of your care.
- Get in touch with your local 211. The specialists on the other end will be able to direct you to dental clinics that offer affordable care.
- If you are 65 and over, disabled, or otherwise medically vulnerable, you can apply for free dental care through Dental Lifeline. This is a service that dentists and dental professionals provide donated dental care. Dental Lifeline operates in every state.
How To Pay For Dental Implants Without Medicaid
If Medicaid wont cover your dental implants, here are some alternative ways to pay for your treatment:
- Cosmetic Dentistry Grant If you cant get Medicaid to pay for your dental implants, you can apply for a Cosmetic Dentistry Grant . These are federal grants for cosmetic dental work. To be accepted, you need documentation proving you have good oral health to ensure the procedure is successful.
- Dental insurance There are individual and family insurance plans. You can get the best cheap dental insurance from a private company or the Affordable Care Act Marketplace. Pay close attention to their implant clauses and annual limits, as dental implants can fall outside the limits.
- Dental schools The cheapest way to get a dental implant is to get it from a student at a dental school. Students work under the supervision of senior dental professionals, so you can rest assured theyll do a good job. The prices of dental work at dental schools are significantly lower.
Below we answer some of the common questions about Medicaid and dental implants.
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Dental Care Can Be Expensive Especially Without Dental Coverage Learn Where To Get Inexpensive Care Even If You Dont Have Insurance
Dental care and healthcare go hand in hand. With that said, health insurance and dental insurance are two completely different policies from one another. Since over 33% of adults in the United States do not have a dental plan that provides coverage for routine checkups, this means that there are millions of people without access to the affordable dental care they need.
You donât need to let price be a barrier between you and care. If youâre an adult without insurance, there are plenty of low-cost ways to find dental care.
Here is everything you need to know:
How To Get Braces And Orthodontic Consultations
We are committed to providing affordable orthodontic care. We work with parents to select the best type of braces for their kids. We take them through the process so that they feel comfortable with the procedure. We also help you find the best payment solution, even if your dental procedure isnt covered by Medicaid. We do this by providing information on payment options if you dont have a Medicaid plan that can take care of it. And then we offer enticing affordable pricing options for our patients and make available payment terms that fit our patients budget.Medicaid and Other Affordable Payment Options for Braces
We offer the following payment options:
- Amerigroup Medicaid
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Dental Schools And Clinics
Dental clinics and dental schools may also serve as viable alternatives for Medicaid patients. Dental clinics often provide services for Medicaid beneficiaries at very low costs. They’re also a good option for dental care without insurance.
Many dental schools run clinics, allowing their dental students to treat Medicaid beneficiaries under the watchful eye of their instructors. The future dentists receive hands-on training, and in exchange, Medicaid patients are charged little or nothing for dental services. School-run clinics are more prevalent in urban areas.
About Medicaid
Medicaid is the nations public health insurance program for people with low incomes, covering 82 million adults, pregnant women, children, seniors and disabled individuals at little or no cost.
Each state operates its own Medicaid program, designing and administering its program within federal guidelines. Medicaid programs are funded through a combination of state and federal funds.Medicaid programs must provide health care services for the following population groups to receive federal funding.
- Pregnant women with low incomes
- Children of low-income families
- Seniors with low incomes
- Parents or caregivers with low incomes
What Are The Medical Reasons To Get Braces
There are many medical reasons to get dental braces. Braces can correct several problems, including:
Overbite
Each state has different guidelines for what is considered a medically necessary reason to receive braces through Medicaid. You should contact your states Medicaid office to determine if you qualify for dental coverage.
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Dental Benefits For Children In Chip
States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Dental coverage in separate CHIP programs is required to include coverage for dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.”
States with a program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. The benchmark dental package must be substantially equal to the the most popular federal employee dental plan for dependents, the most popular plan selected for dependents in the state’s employee dental plan, or dental coverage offered through the most popular commercial insurer in the state.
States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov.
Alternatives To Medicaid Denture Coverage
There are alternative methods to acquire financial help if you reside in a state that does not provide dentures as part of Medicaid benefits.
Dental Insurance
Signing up for a dental insurance plan is one option. Private insurance providers offer family and individual policies and often cover dentures.
Be careful to read the policy description to learn all the specifics of your plan since the premiums, deductibles, and coinsurance amounts will differ across the plans.
There are numerous dental plans in the US that cover dentures or partial dentures.
You can visit Dentalinsurance.com to find the best dental insurance plans in your state. By just entering your zip code and birthday, you may see the most popular options in your area.
Discounts for seniors on dentures
Last but not least, inquire about any senior discounts offered by your local dental office. If they don’t provide a senior discount, they could charge you less if you pay in advance or with cash or a check. Additionally, many dental offices offer third-party financing, often with 0% interest for a short time.
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Does Medicaid Cover Braces For Adults And Kids
Each state has different guidelines for what is considered a medically necessary reason to receive braces through Medicaid. You should contact your states Medicaid office to determine if you qualify for coverage.
Traditional metal braces are the most common braces and use brackets and wires to straighten teeth. If you do not qualify for Medicaid or your orthodontist does not accept Medicaid, other payment options are available, including dental schools, dental clinics, payment plans, and CareCredit.
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How To Shop For Dental Insurance
If you have access to an employer-sponsored dental plan, that is likely going to provide the best value as your employer will probably subsidize a portion of the premiums. But assuming you need to purchase your own dental plan, there are several things to keep in mind:
- The health insurance marketplace/exchange in your state is a good place to start, particularly if you also need to purchase your own health insurance .
- If you have a particular dentist you want to keep seeing, youll want to check with them and see if they recommend any particular dental plans. They may be in-network with some plans and not others. If they do not participate in any dental plan networks, they may offer a discount for paying cash or a participation program that you can purchase and then use for discounts on any of the services they provide.
- When youre comparing dental plans, pay close attention to things like waiting periods , deductibles, benefit caps, and monthly premiums. You may find that its worthwhile to pay a larger premium in order to have more extensive coverage or a shorter waiting period for certain services.
- If youre buying a health plan that has embedded dental coverage , be sure you understand how the coverage works. For example, it may provide free cleanings and exams, but count all other dental services toward the overall medical deductible, which could be several thousand dollars.
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Upcoming Changes To Dental Services In Florida Medicaid
In 2016, the Florida Legislature directed the Agency for Health Care Administration to enroll most Medicaid recipients into dental plans. Recipients will receive a dental plan based on the below schedule. The schedule is separated into phases by the recipients county location.
Recipients will begin to receive letters soon. They will be mailed out about 45 days before each phase starts. For example, recipients will begin to receive letters for Phase 1 in the middle of October. For more information, please click on the following link:
Dental Care For Children Ages 0
- Problem focused
- Pain management
Some Services may require permission from a dental plan before the dentist performs the service. This is called a prior authorization. Services must be medically necessary in order for dental plans to pay for them. For more details about dental services, contact the recipientâs dental plan starting December 1, 2018.
- Additional dental exams
- Dental consultations
- Dental office diabetic testing
- A visit to the dental office to get comfortable with the office and the dentist before dental work is done for persons with disabilities
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The Texas Medicaid Application
To apply for Texas Medicaid, go to yourtexasbenefits.com and click apply for new benefits. Youll be asked to create an account to proceed. From there, you can apply for TX Medicaid, SNAP, TANF cash Help, WIC Food Benefits, and other support. You can also online and send it to the HHSC (Health and Human Services or visit your local HHSC office.
If you need help completing your TX Medicaid application, visit your local HHSC office and ask for assistance. You can also complete your TX Medicaid application verbally by calling 877-541-7905, Monday through Friday from 8 AM to 6 PM.
