Does Medicaid Have Dental Coverage?
Medicaid is a joint venture between the federal and state governments — both pitch in to cover the costs. All states have to meet the federal guidelines, but the specifics of each state's program can vary beyond those federal must-haves.
Whether Medicaid covers dental could depend on your state of residence and your age. Find out more about Medicaid dental coverage to see if you can get dental care under your plan.
Under the federal Medicaid guidelines, all states must provide Medicaid dental coverage for kids who are enrolled in Medicaid and the Children's Health Insurance Program (CHIP). Dental coverage for child enrollees falls under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This benefit includes a comprehensive set of healthcare services available to Medicaid enrollees under the age of 21.
For kids on Medicaid, dental coverage isn't limited to dental emergencies. States are also required to take care of services related to pain relief, infection treatment, teeth restoration and dental health maintenance. Dental treatment must be covered if the situation is deemed medically necessary. The guidelines for determining if a treatment is medically necessary are set by the individual states. Each state also creates a dental periodicity schedule with help from a recognized dental organization.
The answer isn't as clear-cut when it comes to adult dental care. The individual states decide if they'll offer dental coverage for adult enrollees, as well as the type of coverage they'll provide. There's no federal minimum requirement when it comes to adult dental care. It's common for adults to at least receive coverage for dental emergency services, and some states offer comprehensive dental care for adults. To find out if you can get Medicaid dental coverage as an adult, check the coverage provided by your state.
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If your state doesn't offer Medicaid dental coverage for adults, other low-cost options can help you get the dental care you need to keep yourself healthy. Look for these options in your area:
- Dental schools: Students in dental programs need lots of practice to become licensed. They often charge minimal fees for all types of dental procedures and are supervised by practicing dentists. You can also get an affordable cleaning through a local dental hygiene program, which you can often find at community or technical colleges.
- Community health centers: These federally funded health centers offer dental care and other essential health services. The services are typically offered for free or at a reduced rate. They might use a sliding fee scale based on your income to keep the care affordable.
- Local programs: Your state, county or city might offer dental care programs for low-income families. The income requirements vary for these programs and could be different from the Medicaid qualifications.
- Veterans Affairs: If you're a veteran, you might qualify for dental care through the VA. Eligibility depends on your benefits class through the VA. Check with the VA to see if you qualify.
- Dental savings plan: This option isn't the same as dental insurance. You pay a fee each year in exchange for a discount on dental services through participating dental offices. It likely won't cover as much as dental insurance, but it can save you money if you need a significant amount of work and have to pay out of pocket.
- Local dentists: Some dentists offer a certain amount of dental work for a discounted rate to low-income families. They might offer discounts for paying in cash at the time of the service. You might also be able to negotiate a payment plan that lets you spread out the costs over time.
Finding affordable ways to see the dentist helps you maintain your oral health and can prevent more severe health conditions.
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