Some states offer different benefits to adults enrolled in the ACA Medicaid expansion than they offer to other members. In these states, a 55-year-old with Medicaid expansion coverage may not have dental coverage, while a 70-year-old eligible for Medicaid due to a combination of age and financial circumstances could receive dental benefits. The opposite situation is also possible, meaning that a state could cover dental benefits for those enrolled in the expansion, but not for other adults. Medicaid will only pay for dental care from a provider who is enrolled in the state's Medicaid program (or who is part of the state's Medicaid care management network), while some private dental plans require members to use in-network dentists and others don't.
Some states also limit what Medicaid will pay for dental benefits each year, but others don't have a limit, while most private dental plans do have a limit on how much they'll pay in a given year. You can learn more about Medicaid dental care in each state here. Medicaid sometimes covers restorative dental services for adults in both program modules. Restorative care repairs or replaces decayed, damaged, or missing teeth.
Medicaid sometimes covers oral surgery services for adults in both program modules. An oral and maxillofacial surgeon treats diseases, injuries and defects of the mouth, teeth, jaws, face, head and neck. Medicaid pays for oral surgery under the health insurance component when medically necessary. Medicaid pays for other oral surgery services under the dental insurance element in the states that provide the benefit.
If you live in one of the remaining thirty-four states, see below to determine what other emergency dental services your coverage might include. For example, people with oral surgery benefits may have benefits for urgent extractions of painful teeth. Medicaid doesn't seem to cover orthodontic appliances under the dental insurance element in any state. The time to address a disabling malocclusion is before your 21st birthday.
For adults 21 and older, Medicaid will cover at least emergency and medically necessary dental treatments in almost every state. Sometimes Medicaid in specific states chooses to provide coverage in certain situations, such as disabled adults who can't support themselves, pregnant women, and low-income seniors. Therefore, a person who works for a salary low enough to qualify for Medicaid enrollment is generally prohibited from participating in an employer-provided health insurance plan. Since Medicaid is technically a primary health insurance program, it will include some procedures necessary for medical health.
For more information about participating dental providers, covered services for children and adults, and information about in-school dental services, visit the Illinois Department of Health and Family Services website. Many MCOs outsource claims processing to Dental Benefit Administrators (DBM) under the dental insurance element of the program. In other states, such as Georgia, a dental emergency must be life-threatening or performed in an emergency room as part of a major medical procedure. By law, Medicaid is insurance of last resort, which means that all other insurance coverage must be exhausted before a provider can bill Medicaid for the remaining unpaid.
Among adults ages 19 to 64, only 6.7% have Medicaid with dental benefits, and 35.2% of them had Medicaid, but did not have dental insurance. States can choose to provide dental services to their Medicaid-eligible adult population or, as part of their Medicaid program, choose not to provide any type of dental services. The dental insurance element pays for the different layers of emergency dental care associated with tooth decay and gum disease depending on the state of residence. However, dental care is of a different class than these medical services, and Medicaid coverage may be limited.
Dental grants for low-income adults may offer a more viable avenue to fix your teeth if you live in one of the many states with limited or no benefits. Fortunately, there are programs like Medicaid that can help you get low-cost health and dental insurance, depending on the state you live in. Dental services should be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at other intervals, as indicated by medical need, to determine the existence of a suspicion illness or condition. The health insurance component must consistently pay for medically necessary emergency dental work (arising from accidents without bites, certain illnesses, and treatments that are considered an integral part of other services included in the plan) throughout the country.
States are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program (CHIP), but states decide whether to offer dental benefits to adults. . .