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Medicaid is a joint federal and state medical coverage program available to those who meet certain income and asset requirements. This program pays for a number of health services, including procedures, preventive care and emergency room and hospital visits. However, not all medical services are required to be offered to those within the Medicaid program. Dental care is one of those services that is not required to be covered; however, it still is covered in certain states.
Does Medicaid Pay for Dental Care?
Medicaid does pay for dental care services in some states that elect to do so for adults over the age of 21. Medicaid requires dental services to be provided to those under the age of 21 in all states as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
Dental care is a broad term for many different types of services, procedures and treatments all related to your teeth and mouth. This catch-all term includes everything from preventive services (like cleanings and x-rays) to major treatments (like crowns and bridges).
EPSDT coverage is similar to the provision that ensures that children on their parents’ health insurance policies are able to access dental care services as an essential benefit through the Affordable Care Act (ACA) while this benefit is not required to be extended to adults. Regardless, some ACA plan providers elect to offer this coverage for adults who purchase their insurance. In the same way, state governments are required to offer dental care coverage for children on Medicaid under the age of 21 but not to adults. However, individual states elect to extend courage to adults who qualify for Medicaid.
A number of services are mandatory for all states to offer to Medicaid recipients that include basic health care. However, a number of optional services can be offered but are not mandatory. Dental coverage is not considered a mandatory service and, therefore, for Medicaid programs serving adults over this age, it is up to the state whether they will provide dental care or not. This means that whether or not you’re covered depends on where you live.
While certain dental services may be covered by all states’ Medicaid programs, such as emergency care after a major trauma, a lot of procedures and dental care are not offered at all by states. Each individual state is allowed to choose what dental services they wish to cover and how much coverage is to be offered.
Some states, such as California, New York, Oregon and Rhode Island, offer extensive dental care through their Medicaid programs. Other states have more in-between coverage, meaning they offer limited dental coverage. Some of these in-between states include Nevada, Texas and Arizona. A number of states offer limited dental coverage, including Indiana, Michigan, Nebraska and Vermont.
How to Qualify for Medicaid
Medicaid is a joint state and federal program that provides healthcare coverage in the United States to certain groups of individuals. In order to qualify for Medicaid, the individual must fall into one of the groups set by federal law. These groups include low-income families, qualified pregnant women and children and those who receive Supplemental Social Security Income. These groups are mandatory eligibility groups; however, states may choose to cover additional groups.
Eligibility for Medicaid is typically measured by income. The methodology in determining whether a certain income provides Medicaid eligibility was established through the Affordable Care Act. The methodology is based on the Modified Adjusted Gross Income (MAGI), which considers taxable income and tax filing relationships in order to determine eligibility for Medicaid.
The MAGI methodology is not used to determine eligibility for those who are eligible based on blindness, age (over 65) or disability. People within these groups have their eligibility determined by the SSI program.
Other qualifications that must be met are separate from the financial requirements. Individuals must be a citizen of the United States or a qualified non-citizen, and they must be a resident of the state where they are receiving Medicaid.
States also have the ability to establish a medically needy program. These programs offer Medicaid coverage for individuals that have significant needs but have an income that is too high to qualify for Medicaid. These individuals can qualify by spending down their income, which allows them to meet the income requirements by incurring expenses for medical care that they don’t have health insurance for.
Will Your Kids Qualify for Medicaid?
Children will qualify for Medicaid in most states until they reach the age of 19 as long as their family meets the required financial requirements. Some states have a lower family income for children to be eligible, while others may be higher. Some young people may be eligible up until the age of 21.
In the case you do not qualify for Medicaid because your income is too high, but you still need your child’s healthcare to be covered, the Children’s Health Insurance Program (CHIP) is in place. CHIP offers health coverage for children at a low cost. All states offer CHIP coverage, and some states offer it for pregnant women.
EPSDT is the child health program set forth by Medicaid. The program is in place to aid in medical needs, including diagnosis, prevention and treatment of medical conditions. This service is required to be provided by all states under their Medicaid program.
In accordance with EPSDT, dental care must be provided at reasonable intervals to meet the standards of proper dental care. For EPSDT recipients, dental care is not limited to only emergency services.
Finding a Dentist That Accepts Medicaid
The first step in finding a dentist that accepts Medicaid is to determine whether the state you live in and receive Medicaid through offers dental coverage for adults. Once you’ve determined that dental coverage is offered in the state, you can call around to find a dentist that accepts it. You can start with the dentist you’ve gone to see in the past, as they may accept it. An internet search can help you find a dentist easily. Know that most dentists do accept Medicaid coverage, so you shouldn’t have a very hard time finding accessible dental care as a Medicaid recipient.
Is Medicaid Medical Separate From Dental Coverage?
Medicaid medical is separate from dental coverage as they are two separate coverages offered. Medicaid medical refers to medical coverage while dental coverage refers to dental care. While all state Medicaid programs provide medical coverage, not all offer dental care coverage.
Medicaid is required to offer coverage for a number of certain services, including hospital visits, physician visits, transportation to healthcare and home health services. These services are considered Medicaid medical. Dental services are not included on the list of mandatory health services. Instead, dental coverage is under the optional benefits list that allows each state to choose whether they wish to offer dental coverage or not.
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Dental care is not a required benefit under Medicaid’s guidelines. Though many states elect to offer dental care coverage, you might live in a state that does not elect to cover dental care costs. Even if you do live in a state with some form of covered dental care, you may only be able to use this benefit in emergency situations.
If you don’t have dental coverage under your state’s Medicaid program, you have the option to purchase an independent dental insurance plan provider. Dental insurance policies are significantly more affordable when compared to ACA-compliant health insurance plans, and you may be able to find coverage for just a few dollars a month. Explore a few recommended dental insurance providers using the reviews and links below.
- securely through UnitedHealthcare Dental's websiteBest For:Large suite of productsRating:
- securely through Spirit Dental & Vision's websiteBest For:Dental + Vision PlansRating:
- securely through Ameritas Dental Insurance's websiteBest For:Adult and child orthodontia benefitsRating:
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Frequently Asked Questions
Does Medicaid cover dental crowns?
Since each state can set forth what is covered by Medicaid dental care, whether Medicaid covers dental crowns is dependent on the state. For example, Alaska, North Dakota and Pennsylvania offer coverage for dental crowns, but South Carolina and Washington do not offer this coverage. Additionally, some states only offer coverage for emergency issues.
What does Medicaid pay for?
What Medicaid pays for is determined by each state in accordance with broad federal guidelines. Some mandatory services that Medicaid pays for include inpatient and outpatient hospital services, physician services, laboratory and x-ray services, family planning services, certified pediatric and family nurse practitioner services and several more. Depending on where you live, Medicaid may also pay for additional services like dental care services and vision coverage.
What's the difference between Medicare and Medicaid?
Medicare is a health insurance program for people who are older than 65 or are younger and disabled. Medicaid is a program for low-income people.
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