Would you believe more than 28 million people in the United States have dental benefits through Medicaid? That’s a lot of people! If you are one of them, rest assured, you aren’t alone. While Medicaid is an invaluable health care plan that has helped millions of Americans get the medical and dental care they need, it can also be confusing and difficult to navigate.
- Not all states offer comprehensive dental coverage under Medicaid. While Medicaid is a federal program, dental coverage is administered by the individual states, which means that benefits can vary widely from one state to another. Some states offer comprehensive dental coverage, while others offer only emergency services or limited coverage for certain procedures.
- Medicaid dental benefits are primarily focused on children. While some states do offer dental coverage to adults, Medicaid dental benefits are primarily aimed at children. This is because dental problems can have a significant impact on a child’s overall health, including their ability to eat, sleep, and learn.
- Medicaid dental benefits may be limited to certain providers. In some states, Medicaid dental benefits are only available through certain providers, such as community health centers or clinics. This can limit access to care for some Medicaid beneficiaries, particularly those living in rural areas.
- Medicaid dental benefits may have limits on certain procedures. Even in states where comprehensive dental coverage is available, there may be limits on certain procedures or treatments. For example, some states may only cover a certain number of cleanings or fillings per year, or may require prior authorization for certain procedures.
- Medicaid dental benefits may not cover cosmetic procedures. Medicaid dental benefits are focused on addressing dental problems that impact a person’s health or ability to function. As such, cosmetic procedures, such as teeth whitening or veneers, are generally not covered.
- Medicaid dental benefits may require copays or other out-of-pocket costs. While Medicaid dental benefits are designed to help low-income individuals access care, some states may require beneficiaries to pay copays or other out-of-pocket costs for certain procedures or treatments.
- Medicaid dental benefits may not cover orthodontic treatment. While some states do cover orthodontic treatment under Medicaid, it is generally not considered a medically necessary procedure and may not be covered. When coverage is available, there may be strict eligibility criteria and waiting lists for treatment.
Medicaid Dental Benefits Basics
While it would take the rest of the year to dig through all of the rules and regulations surrounding Medicaid, we dug up a few basic things you may not know about them.
- They are not required for adults – while 46 states and the District of Columbia offer some level of them for adults, not all states do. Which brings us to our next fact.
- They vary by state – in some cases widely. In some states like Arizona, the Medicaid dental benefit only offers emergency benefits, while other states like New Mexico offer far more extensive benefits including preventive and specialty dental care.
- They can vary within the state – with the expansion of Medicaid coverage in 2016, some states provide additional benefits to the original Medicaid population that the expanded population doesn’t receive.
- They are often not called Medicaid – plan names vary widely by state, but ultimately are funded under Medicaid.
- Plan years vary by state – in some states, they are calculated on the anniversary of enrollment; in others, the benefit period resets on the same day every year. For example, in Colorado, They renew annually on July 1st.
- Only 20% of dentists nationwide accept Medicaid – a select group that we’re proud to be included in! Select PERFECT TEETH practices in Colorado and New Mexico accept Medicaid.
Unbelievably, every year, millions of Medicaid dental benefits dollars go unused. Don’t let that happen to you! If you have dental benefits under Medicaid, make sure you take advantage of them to keep your mouth and yourself healthy. If you have questions about your Medicaid dental benefits in Colorado or New Mexico, or need to schedule your next dental appointment, we’d love to help!