Dental Benefits For Children In Medicaid
Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment benefit. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state.
Dental services for children must minimally include:
- Relief of pain and infections
- Restoration of teeth
- Maintenance of dental health
The EPSDT benefit requires that all services must be provided if determined medically necessary. States determine medical necessity. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state’s Medicaid plan.
Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Dental services may not be limited to emergency services for children entitled to EPSDT.
Children’s Oral Health Initiative
The Centers for Medicare & Medicaid Services is committed to improving access to dental and oral health services for children enrolled in Medicaid and CHIP. We have been making considerable progress in our efforts to ensure that low-income children have access to oral health care. From 2007 to 2011, almost half of all states achieved at least a ten percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service during the reporting year. Yet, tooth decay remains one of the most common chronic childhood diseases.
To support continued progress, in 2010 CMS launched the Children’s Oral Health Initiative and set goals for improvement by FFY 2015. To achieve those goals, we have adopted a national oral health strategy through which we are working diligently with states and federal partners, as well as the dental provider community, children’s advocates and other stakeholders to improve children’s access to dental care.
To support state Medicaid and CHIP programs in achieving their improvement goals, we developed Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents. It provides an overview of the children’s dental benefit in Medicaid, support for evidence-based policies at the state level, and details of successful strategies with state examples.
Pediatric Dental Benefits In Pennsylvania
The stand-alone pediatric dental plans available in Pennsylvania comply with the ACAs pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care will not exceed $375 per child in 2022 , and there is no cap on medically-necessary pediatric dental benefits.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the states essential health benefits benchmark plan.
The Pennsylvania benchmark plan does include coverage for both basic and major dental services for children.
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Other Necessary Health Care Services
States are required to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state’s Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.
What Dental Coverage Does Medicare Provide Pennsylvania Patients
The answer to the question Does Medicaid cover dentalwork? depends first on your Pennsylvania MA eligibility. Assuming you meet the programs requirements, Medicaid may indeed cover certain dental services.
All states, for example, are required to provide dental benefits to children covered by Medicaid and the Childrens Health Insurance Program . Covered services include:
- Cavity fillings
Children may be eligible for additional dental treatments depending on their specific Medicaid plan and benefit limit.
Individual state Medicare programs choose whether to provide dental benefits to adults. According to the Centers for Medicare & Medicaid Services , While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care.
In Pennsylvania, Medicaid-covered dental services for adults are those dictated by medical necessity, including:
- Exams and X-rays
- Extractions and other oral surgeries
- Palliative treatment for pain and symptoms
Medicaid limits diagnostic and preventive services to once every 180 days per adult recipient. Additional evaluations, cleanings, and dental procedures, including root canals and crowns, require approved exceptions.
You may have questions about whether medicaid in PA covers dentures and implants. Here are your answers:
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What Is A Prior Authorization And How Do I Get One
If you have questions about prior authorization please call Customer Service at , Monday Friday, 8 a.m. – 6 p.m. Central Time.
Providers can check on the status of an existing request by calling our clinical authorization services at , 24 hours a day, seven days a week.
If you have questions about a pharmacy prior authorization, please call our Pharmacy Help Desk at . You can get answers to prescription prior authorization questions Monday Friday, 7 a.m. to 7 p.m. Central Time, with voicemail intake after-hours.
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.
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Epsdt Strategy Guides To Support States With The Medicaid Benefit For Children And Adolescents
In 1967, Congress introduced the Medicaid benefit for children and adolescents, known as Early and Periodic Screening, Diagnostic and Treatment . The goal of this benefit is to ensure that children under the age of 21 who are enrolled in Medicaid receive age-appropriate screening, preventive services, and treatment services that are medically necessary to correct or ameliorate any identified conditions the right care to the right child at the right time in the right setting. This broad scope supports a comprehensive, high-quality health benefit. States share responsibility for implementing the EPSDT benefit with the Centers for Medicare & Medicaid Services.
As one outcome of a National EPSDT Improvement Workgroup, the Center for Medicaid & CHIP Services is developing a set of strategy guides, each on a specific topic, to support states and their partners as they implement the EPSDT benefit. Each strategy guide identifies specific, doable approaches to improve access, utilization and quality of care for children and adolescents enrolled in Medicaid. Examples of state successes are offered along with web-based links to resources, tools and more in-depth.
The first four guides in the series are:
Seven Insurers Offer Stand
In 2022, seven insurers offers stand-alone individual/family dental coverage through the health insurance marketplace in Pennsylvania. These are dental plans that are not included with a medical plan and must be purchased separately:
This coverage can be purchased through Pennie during open enrollment or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACAs rules for pediatric dental coverage.
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Dental Insurance In Pennsylvania
Pennsylvania operates a state-run health insurance exchange called Pennie for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the Pennsylvania exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
How Can I Make A Same
On average, patients who use Zocdoc can search for a Dentist in Pittsburgh who takes Medicaid insurance, book an appointment, and see the Dentist within 24 hours. Same-day appointments are often available, you can search for real-time availability of Dentists in Pittsburgh who accept Medicaid insurance and make an appointment online.
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Use The Links Below To Start Your Search
Doctor.com can help you find a Dentist who accepts Medicaid insurance in Pennsylvania. A dentist is a person qualified by a doctorate in dental surgery or dental medicine , licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association’s Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Healthy Families Safe Communities
We invite you to partner with Keystone First and join us in making a long-term commitment to being anti-violence advocates. We are launching Healthy Families, Safe Communities, an education campaign including materials and resources for both members and providers.
This program will address many issues, including gun safety, dating safety, and prescription medicine abuse.
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Can I Buy Dental Insurance Outside Of Pennsylvanias Exchange
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Keystone State. These plans are not subject to the ACAs essential health benefit rules for pediatric dental coverage, but they are regulated by the Pennsylvania Insurance Department. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In Pennsylvania, there are also various dental discount plans available. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Learn about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Unitedhealthcare Connected For Mycare Ohio
UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.
Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
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State Oral Health Action Plans
To support the Oral health Initiative, CMS invited state Medicaid agencies to develop State Oral Health Action Plans as a roadmap to achieving in their goals.
CMS has received SOHAPs from the following 25 states: Alabama, Alaska, Arizona, California, Connecticut, District of Columbia, Delaware, Florida, Maine, , Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Tennessee, Utah, Vermont, Virginia, Washington and Wyoming. CMS encourages the remaining 29 states to develop and submit their SOHAPs, and CMS stands ready to provide technical assistance to any state that requests it.
SOHAPs may be submitted using either a CMS-developed Oral Health Action Plan Template or a user-friendly template developed by the Medicaid-CHIP State Dental Association. Completed SOHAPs may be submitted to Andrew Snyder, Health Insurance Specialist via email to with a copy to your CMS Regional Office contact. Any questions about the SOHAPs may also be directed to Mr. Snyder.
Are Video Visits With A Dentist Online Covered By Medicaid
Most insurers provide coverage for video visits at the same cost as in-person visits. You can search on Zocdoc specifically for Dentists in Pittsburgh who accept Medicaid for video visits by selecting your carrier and plan from the drop-down menu at the top of the page. We recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.
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Find A Dentist In Pennsylvania
Tooth decay is the most common preventable chronic disease among children in the United States. If left untreated, it can negatively affect a child’s physical and social development, as well as his or her school performance.
Medicaid and the Children’s Health Insurance Program cover dental services, including check-ups, x-rays, fluoride treatments, dental sealants, fillings, and more.
Unitedhealthcare Connected General Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
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As Part Of Amerihealth Caritas Pa Chc You Receive The Following Dental Benefits:
- 1 dental exam and 1 cleaning, per provider/group, every 180 days .
- Dental emergencies.
- Re-cementing of crowns .
- Periodontal services.*
- Anesthesia*, general anesthesia/OV or non-IV conscious sedation.
*Prior authorization is required and medical necessity must be demonstrated. Some dental services have limits.
There may be copays for some dental services. Please see the Participant Copayment Schedule for more information.
Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
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Pdm Makes Dental Procedures More Affordable For More Patients
Regular dental care is crucial to promoting positive oral health and overall health. At PDM, we do all we can to keep financial cost from being a barrier to the services they need and deserve.
We work with patients in lower-income areas and in other underserved populations to help make comprehensive dental care available, easier to understandand more affordable.
PDM makes sure we advise each of our patients about the estimated cost of their recommended dental work. Our student dentists will help answer any questions you may have about treatment costs prior to treatment.
In addition to accepting direct payments from most dental insurance plans, PDM accepts all Medicaid plans offered to residents of Southeastern Pennsylvania.
Do you want to know more about finding low-cost, high quality dental care? Request your free copy of our eBook, Dental Work Without the Stress. It will help give you peace of mind about receiving important dental treatment, as well as handling their financial cost.
Help When You Need It
With UnitedHealthcare, you’re never alone. Our Member Services is available to answer your questions and help you get the care you need. Just call us at . We can help you between 8 a.m. and 5 p.m. Monday, Tuesday, Thursday, and Friday and 8 a.m. to 8 p.m. on Wednesday. And remember, you can call your UnitedHealthcare doctor any time, any day.
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Developmental And Behavioral Screening
Periodic developmental and behavioral screening during early childhood is essential to identify possible delays in growth and development, when steps to address deficits can be most effective. These screenings are required for children enrolled in Medicaid, and are also covered for children enrolled in CHIP. This CMS Fact Sheet describes CMS resources to support states in ensuring enrolled children receive these screenings. Birth to 5: Watch Me Thrive!, a joint effort between the Department of Health and Human Services and the Department of Education, provides additional resources to support states, providers and communities to increase developmental and behavioral screening of young children.
