Medicaid is a public health insurance program for low-income people that covers medical and dental expenses. It's a joint effort between the federal government and states. The federal government sets the basic coverage rules, and the states determine their own eligibility criteria and any additional services they cover. For this reason, dental coverage under Medicaid varies depending on the state.
Children Under Age 21
Federal law requires all state Medicaid programs to cover dental care for children. These services include regular dental checkups, treatment of infections, and repair of damaged or decayed teeth. Medicaid must pay for all medically necessary dental procedures for children, even if the procedure is not covered under the state's regular Medicaid dental benefits.
People Over Age 21
Each state can choose to cover adults over age 21. Medicaid programs that offer dental care to adults usually cover annual dental exams, preventive care and treatment of problems such as cavities, gum disease and other damage as necessary.
Emergency Dental Care
All state Medicaid programs cover emergency dental services for children. Most Medicaid programs also cover emergency care for adults. Emergency care includes repair of broken teeth, treatment of extensive infection and extraction of decayed teeth causing extreme pain.
Covered Procedures
Medicaid dental programs only cover medically necessary procedures and basic preventive care. Procedures Medicaid covers include cleanings, fluoride treatments, crowns and fillings, X-rays, root canals, extractions and dentures. Medicaid will not pay for cosmetic dental services, such as braces, veneers or teeth whitening.
References
- Utah Department of Health: Dental Benefits
- National Association of Dental Plans. "Who has dental benefits today?" Accessed July 31, 2020.
- Aetna. "Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans." Accessed July 31, 2020.
- Healthinsurance.org. "What’s the difference between dental insurance and dental discount plans?" Accessed July 31, 2020.
- National Association of Dental Plans. "Who do dental plans normally cover?" Accessed July 31, 2020.
- Consumer Reports. "Think Twice Before Buying Private Dental Insurance." Accessed July 31, 2020.
- OralB. "How Much Do Braces Cost?" Accessed July 31, 2020.
- CarePlusDentalPlans. "Cosmetic Dentistry Insurance." Accessed July 31, 2020.
- DentalPlans.com. "What Are Dental Savings Plans?" Accessed July 31, 2020.
- ADA. "What Does My Plan Cover?" Accessed July 31, 2020.
- Healthcare.gov. "Using a Flexible Spending Plan." Accessed July 31, 2020.
- KFF. "Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries." Accessed July 31, 2020.
- Healthcare.gov. "Dental coverage in the Marketplace." Accessed July 31, 2020.
- Cigna. "Full Coverage Dental Insurance." Accessed July 31, 2020.
- ADA. "What Are the Different Types of Dental Plans?" Accessed July 31, 2020.
- HarborBreeze. "In House Dental Plan." Accessed July 31, 2020.
- Humana.com. "The scoop on dental discount plans." Accessed July 31, 2020.
Writer Bio
Lauren Treadwell studied finance at Western Governors University and is an associate of the National Association of Personal Financial Advisors. Treadwell provides content to a number of prominent organizations, including Wise Bread, FindLaw and Discover Financial. As a high school student, she offered financial literacy lessons to fellow students.