Does Medicaid Pay For Dental Work


Give The Bill To Medicaid

Does Medicare Pay for Dental?

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.

But Is It Safe To Visit The Dentist

While the COVID-19 vaccine provides some hope of reducing the spread of the coronavirus, some dental patients are still curious about dental safety. How safe is it right now to go to the dentist? According to the American Dental Association , its not only safe to visit the dentistits encouraged!

Because routine dental care is crucial to promoting positive oral health and overall health, its considered an essential service and is therefore recommended.

Plus, since PDM operates in conjunction with the University of Pennsylvania School of Dental Medicine, we remain at the forefront of the latest research and practices in dentistryincluding how to maximize safety

Next Steps

If youd like to learn more about what dental procedures are covered as part of your PA Medicaid dental benefits, call the PDM office at 215-898-8965 to schedule your appointment. Or, to contact us for questions.

Medicare Supplement Dental Insurance

If you need a supplement to your Medicare dental care to help cover costs, ask your dentist if they offer a dental savings plan. You can also purchase a supplemental dental insurance policy. To pursue either of these options, talk with your dentist and call your preferred insurance provider to learn about all of your options.

Also, check out our article that talks about affordable dental insurance for seniors for more information on finding low-cost dental care if you are 65 years or older.

To recap, the following video provides a clear summary of Medicare dental coverage and what services are included:

Read Also: Phone Number For California Medicaid

Does Medicaid Cover Dental Implants For Patients Over 21 Years

Whether or not Medicaid will pay for dental implants if youre over 21 years will mainly depend on the US State you reside in.

Medicaid differs from State to State with regard to the various kinds of dedicated dental procedures their programs may offer patients over 21 years.

The dental implant process has various stages, and its for this reason, Medicaid may pay for some parts of the procedure.

Medicaid may only pay for the early stages of the procedure. Some of the stages of the dental implant procedure that Medicaid may pay for include:

  • CT scans: This stage is meant to determine your bone structure and find any structural irregularities.
  • Tooth removal due to an accident, disease, or chronic health condition.
  • Bone grafting because of an accident, disease, or chronic health condition.
  • Surgical installation of the implant frame into the bone of your jaw.
  • However, its important to note that dental procedures for adults paid for by Medicaid are limited because not many dental practitioners in the US accept Medicaid coverage.

    In fact, studies show that only 38% of them accept Medicaid.

    What Are Dental Implants

    Does Medicaid Pay For Teeth Cleaning

    Does Medicaid Cover Dental Implants

    Dental implants are surgical procedures whereby a structure is placed into the jawbone to replace a portion of the missing tooth.

    Once in place, a component known as an abutment connects the implant to the physical tooth.

    The process of a dental implant majorly depends on the condition of your jawbone.

    Initially, the dental surgeon must conduct an extensive assessment of your dental wellbeing via a dental examination to determine if an implant suits your needs.

    Dental implants offer a welcome alternative to bridgework or dentures, which dont always fit well.

    Dental implants are also an option for patients who dont have natural roots and cannot undergo entire tooth replacements.

    Recommended Reading: Does Medicaid Cover Glasses In Texas

    How Often Will Medicaid Pay For Dentures

    Most states covering denture services offer replacement dentures every 5 to 10 years, but some offer only one set of dentures per lifetime. Many states place limits on the dental services they will cover within a certain time frame. Nine states have annual dollar limits, ranging from $500 to $2,500 a year .

    Does Maryland Medicaid Cover Dental

    One of the most difficult parts of navigating the Medicaid program is obtaining affordable dental care as an adult. Taking care of dental issues is not only a matter of avoiding cavities, but it can actually save lives. Research has shown that dental problems can go on to affect vital organs, including the heart, through infection and other ailments. In many cases, serious dental problems like abscesses arent even apparent until they require urgent care, leaving many people with limited income or access to dental professionals to roll the dice each and every day. As a result, its more important than ever to address dental health concerns as soon as possible.

    Does Maryland Medicaid Cover Dental?

    As of 2019, a little over half of all states have some form of adult dental care as a benefit covered by Medicaid, but Maryland is not one of these states. There have been efforts in recent years to change the Medicaid system in Maryland to include an adult dental benefit, but for now, only pilot programs are in place that provide limited access for individuals who receive both Medicare and Medicaid services. This means that adults in the state are not covered for dental work by Medicaid alone.

    Alternative Dental Care Options for Residents of Maryland

    Related articles:

    Don’t Miss: Neurologist In Alexandria La That Accept Medicaid

    What You Should Know About Masshealth

    Like its counterpart, Massachusetts own health insurance program is designed to help low- to medium-income residents and even offers a program for HIV positive patients. The initiative also manages the Insurance Partnership for small businesses, the Childrens Medical Security Plan, Special Kids/Special Care Pilot Program, and Healthy Start.

    Now if you want to apply for the MassHealth coverage, you need to be one of the following:

    • Children and their parents/caretakers
    • Patients who require long-term care
    • Breast or cervical cancer sufferers
    • HIV positive patients
    • Clients of the Department of Mental Health

    Even if you have health insurance, you can apply for MassHealth coverage since the Executive Office of Health and Human Services assesses eligibility based on family income.

    Bidens Social Policy And Climate Bill At A Glance

    What You Need to Know about Medicaid Insurance and Dental Implants? | Dr. Parsa Zadeh

    The centerpiece of Bidens domestic agenda.The sprawling $2.2 trillion spending bill aims to battle climate change, expand health care and bolster the social safety net. Heres a look at some key provisions and how they might affect you:

    Child care.The proposal would provide universal pre-K for all children ages 3 and 4 and subsidized child care for many families. The bill also extends an expanded tax credit for parents through 2022.

    Read Also: Nursing Homes That Accept Medicaid

    Do Medicaid And Medicare Cover Dental Guide To Low

    The topic of Medicare and Medicaid dental coverage causes a lot of confusion for people looking for a way to help pay for dental work. And even if you do find low-cost dental care, it can be difficult to find dentists that accept Medicaid or dentists that provide low-income options.

    There are a plethora of questions surrounding healthcare and especially dental care in the US.

    Confused about Medicaid and dental?

    Do you want to know about state-funded and federally-funded healthcare?

    Or maybe you’re just wondering where you can find dental clinics for low-income families or individuals.

    Oh yeah, and what in the world is CHIP by the way? .

    It doesn’t matter what your beliefs are when it comes to the current healthcare debate surrounding health insurance in the US when you need dental care, you need dental care.

    The good news is, once you understand a little bit better how the system works, who to contact for which service, and which Medicare and Medicaid dental benefits you may be eligible for, the process becomes much easier. And you may find yourself among the many Americans who manage to find dental care despite the confusing system.

    That’s why this article will cover everything you need to know about state-funded health insurance and low-cost dental options, including:

    • Medicare dental coverage
  • 6.8 Does Medicaid cover dental braces?
  • Services Requiring Prior Authorizations

    All requests must demonstrate medical necessity and contain the minimum document requirement for review. Prior Authorizations Requests must be submitted electronically via provider portal. If a prior authorization is missing the minimum documents required, OHCA reviewers will cancel authorization for insufficient documentation. Provides must resubmit a new PAR with all required documentation.

    Minimum required records to be submitted with each dental PAR are:

  • A comprehensive treatment plan containing members treatment history and clinical notes,
  • Right and left mounted bitewing x-rays or panoramic x-ray, and
  • Periapical films of tooth/teeth involved displaying 3mm beyond the apex of the tooth as stated in policy.
  • X-rays and/or images must be identified by the tooth number and include date of exposure, member name, member ID, provider name, and provider ID. All x-rays or images, regardless of the media, must be submitted together with a completed and signed comprehensive treatment plan that details all needed treatment at the time of examination. The film/print must also clearly identify the requested service. If you are requesting periodontal services, please also send periodontal charting. Records will not be returned.

    Please note that providers are notified via the OHCA Provider Portal as to whether services are denied or approved. A letter is also mailed to the members family.

    The following information is required to process all requests for comprehensive orthodontics :

    Don’t Miss: How To Get Approved For Medicaid In Florida

    Does Medicare Cover Invisible Aligners

    Invisible aligners like Smile Direct Club help straighten teeth but arent as noticeable as braces. Medicare wont cover invisible aligners.

    But, some insurance companies usually treat aligners the same as braces. If your dental insurance includes orthodontic work, it will typically cover aligners.

    With that said, it may be hard to find insurance that includes adult orthodontic coverage. If you do, you can expect to pay a percentage of the cost. Another option is to buy into a dental discount program that offers a discount on aligners.

    Can You Get Special Consideration For Medicaid To Cover Your Dental Implants

    Does Medicaid Cover Dental in Florida?

    If youre sure that you need to get dental implants, you might be able to obtain special consideration from Medicaid.

    Basically, you have to provide evidence that the procedure is medically necessary rather than for cosmetic purposes.

    It will be a long and daunting process, but to obtain prior consent from a Medicaid provider, you will have to provide supportive documents from a physician or dental practitioner.

    Some of the documents you might need include:

  • An account of how dental implants will help your medical State.
  • An explanation from your physician or dental surgeon indicating why other functional alternatives for teeth replacement such as denture fitting or bridgework arent suited to your needs, thereby necessitating the dental implant procedure.
  • An entire mouth radiograph or analytical panorex. A panorex is an exclusive 2D X-ray mainly used in dental procedures to show the State of the upper and lower teeth and the jaws on the same picture.
  • The entire dental implant procedure program.
  • If you have any other conditions being treated for, the physician should indicate them and also any medication youre taking should be specified.

    Read Also: Does Maryland Medicaid Cover Abortions

    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 disability if applicable

    Caries Risk Assessment Dental Codes

    The Oklahoma Health Care Authority has introduced coverage of caries risk assessment dental codes D0601, D0602 and D0603. The concept of risk-based dental caries management is not new and is based on the belief that dentists can use certain indicators to classify caries risk status. Assessment should allow for targeted patient/guardian education and engagement in the caries prevention process. Use of this tool will also aid in more accurate predictions of future caries experience and provide a basis to determine if preventive services can be planned more appropriately with the data obtained.

    Your evaluation of each individual members caries risk will determine the correct D code to submit for reimbursement – depending upon whether the member is found to be low, moderate or high risk. All signatures and boxes must be completed. The caries risk code submitted for payment must reflect the findings on the completed form. The assessment may be reimbursed once per member per year. Submission of the OHCA Caries Risk Assessment Form is now required, in addition to the DEN-2 form, when referring SoonerCare members for orthodontic treatment.

    If you have additional questions or comments, contact the OHCA Dental Unit at 522-7401.

    Recommended Reading: Medicaid Office On Dauphin Street

    Types Of Medicaid Plans Including Dental

    The type of Medicaid that you have could impact whether it pays for dental work for adults. Each state offers a variety of plans designed for different groups of low-income individuals.

    In addition to the straight or regular program, you could enroll in unique plans for pregnant women, dual-eligible Medicare recipients, and individuals deemed medically needy.

    Medicare Dental Coverage Under Medicare Advantage

    What options do you have when Medicaid denies your dental implants?

    If youd like to get more comprehensive dental coverage under Medicare, you might want to consider a Medicare Advantage plan, available under the Medicare Part C program. Offered through Medicare-contracted private insurance companies, these plans are required to offer at least the same coverage as Original Medicare in other words, a Medicare Advantage plan would cover dental care under the same situations as Original Medicare. In addition, many Medicare Advantage plans offer additional benefits such as routine dental or vision care, wellness programs, and prescription drug coverage.

    While Medicare dental benefits may vary by plan, some of the services you may be covered under a Medicare Advantage plan may include routine dental exams, cleanings, X-rays, fillings, crowns, root canals, and more. Some Medicare Advantage plans may require you to use dentists in provider networks when receiving care, or you may have the option to use non-network dentists but at a higher cost-sharing level you can check with the specific plan youre considering for more details.

    Keep in mind that there may be certain costs related to your dental coverage, including deductibles, copayments, and or/coinsurance. In addition, youll need to keep paying your Part B premium if you enroll in a Medicare Advantage plan, along with any monthly premium required for your plan.

    You May Like: How To Get In Touch With Medicaid

    Does Louisiana Dental Accept Medicaid

    Effective January 1, 2021, the Louisiana Department of Health has contracted with DentaQuest and MCNA Dental to provide dental benefits for qualified Medicaid enrollees. These plans are accountable to LDH and the state of Louisiana. Their contract requires adherence to detailed grievance and appeals requirements.

    What Dental Procedures Does Medicaid Cover

    Medicaid typically covers some dental services for children, no such requirement exists for adult coverage. States decide what dental services they will cover for adults, so the benefits vary widely from state to state. Medicaid expansion in some states means that adults who previously werent eligible for any dental coverage through Medicaid may now get routine exams, cleanings, and some other basic services covered by Medicaid in their state. To find out if your state covers services like braces, dentures, root canals, wisdom teeth removal, or veneers, contact your local Medicaid office.

    Many states limit coverage to only tooth extractions or to specific demographics, such as pregnant women. With the wide flexibility given to the states, many provide only emergency dental services for adult patients. Medicaid does not set a minimum requirement for the dental coverage states provide to adults like they do for children.¹²

    As of September 2019, less than half of state Medicaid programs offered comprehensive adult dental benefits. But nearly all 47 states and the District of Columbia offered at least emergency services to their adult Medicaid patients. Emergency services include uncontrolled bleeding and traumatic injuries.¹³

    Don’t Miss: Does Medicaid Cover Counseling In Texas

    Services For Waiver Members With Developmental Disabilities

    Dental benefits are available for adult SoonerCare members served through the In-Home Supports Waiver or Community Waiver. Adults with developmental disabilities served in these waivers are evaluated by their case managers for initial services such as a general exam, cleaning and x-rays. Requests for additional treatment may now be directed to the case manager to include up to $1,000 per plan of care in services.

    All services must be prior authorized by the members case manager. The Oklahoma Department of Human Services Developmental Disabilities Services has prepared information packets about the benefits to distribute to interested dental providers. Packets are available upon request from Julie Whitworth at the DHS state office, 405-521-2237.


    More like this

    How Do I Sign Up For Pregnancy Medicaid

    Can Uninsured...

    Does Medicaid Cover Lo Loestrin Fe

    You Are...

    Dentist Who Accept Medicaid For Braces

    Why Medicaid...

    Can Medicaid Take My Settlement Money

    What Are...