Are Dental Implants Covered Under Medicaid?

Determining whether your dental implants will be covered by Medicaid can help you access these treatments with less stress and worry. Does Medicaid cover dental implants? There is no simple answer to this question.

Medicaid may help pay for some dental care, but if your dental procedure is deemed to be cosmetic, Medicaid will almost always deny coverage for these plans. Here are the basic facts you need to know about Medicaid coverage for dental implants.

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Are Dental Implants Covered by Insurance?

In most cases, Medicaid will not cover dental implants. This is because Medicaid is a government program that is intended to provide added financial support for low-income families who might not otherwise be able to afford dental and medical care.

Dental implants are usually considered to be cosmetic procedures that are not essential to the health and well-being of covered individuals. These elective procedures are usually denied for coverage by Medicaid. There are some exceptions, however.

Patients who can demonstrate that they have a significant and documented medical need for dental implants may be approved for these procedures. This will generally require detailed paperwork completed by your physician or dentist, including a letter that explains why dental implants are the only feasible method for correcting your dental condition.

Your doctor or dentist will also need to provide dental X-rays and a comprehensive treatment plan to your Medicaid provider. In most cases, however, your application for dental implants will still be denied by Medicaid.

Medicaid recipients who are under the age of 21 may also be eligible to have a portion of the cost of their dental implants paid for through this federal program. Children, teens and young adults who receive Medicaid are entitled to receive Early and Periodic Screening, Diagnostic and Treatment (EPSDT) through the program.

Medicaid covers dental implants and will generally pay for the treatments and procedures performed under EPSDT, if dental implants are required. Medicare will give free dental implants for low income families under the age of 21. Patients over 21, however, are not eligible for EPSDT coverage.

Procedures Not Covered by Medicaid

Dental implants fall into the category of treatments not generally covered by Medicaid. Other excluded dental procedures include:

• Dental appliances, which include dentures and dental retainers
• Extractions
• Bridges and crowns
• Teeth cleanings
• Routine examinations
• Fillings

These treatment options are available only if they are medically necessary to protect your health and well-being.

What Dental Procedures Does Medicaid Cover?

In general, Medicaid will only cover dental treatments that are performed to prepare you for an upcoming and necessary medical procedure. This could involve extracting teeth to prepare you for reconstructive surgery after a serious auto accident or providing you with dentures to manage health issues involved with missing teeth.

Other coverage offered by Medicaid will vary from state to state:

• Some states offer no dental care coverage through Medicaid.
• Others may impose a dollar-amount limit on the dental care covered by Medicaid in their state.
• States may offer some care for those under the age of 21 while denying coverage to adults.
• Emergency-only dental services may be covered by the state under Medicaid.
• Some states do offer an optional plan that includes dental, vision and chiropractic services for an additional monthly fee.
• In some states, Medicaid is currently being expanded to offer basic dental care services to patients. This can often improve their state of health to reduce the overall cost of Medicaid coverage in these areas.