Medicaid is a federal program that is administered by the individual states. It provides health coverage for low-income families and individuals who would otherwise not be able to get the medical care they need. The Medicaid program does include coverage for dental services.
While the federal government sets the requirements for the program, each state has the power to make some modifications to what is included in the coverage. This is especially true of dental care for adults, which varies wildly from one state to another.
Dental implants are becoming more common and accessible, leaving Medicaid beneficiaries wondering if they are included in their dental benefits. The answer isn’t so simple.
Medicaid coverage for dental implants
Dental implants costs are typically not covered for adults on Medicaid. The program is designed to provide basic healthcare needs and implants are often considered cosmetic, or at least not detrimental to a person’s health.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) are the benefits that children on Medicaid are entitled to. This includes children up to 21 years of age. If someone under that age requires dental implants, the program will often pay for a portion of the cost, though never the entire expense.
If a patient can demonstrate they have a significant, documented medical need for a dental implant, they may be able to get the procedure approved. The treating dentist and physician must fill out paperwork and include a narrative that explains why dental implants are the only way to correct the dentition.
They will also need to provide supporting information like X-rays, images, and a detailed treatment plan. Even after all this work, the program will still likely deny coverage for implants.
Alternatives to Medicaid dental implants coverage
Fortunately, there are other options to make dental implants more affordable.
Dental implant insurance
Dental insurance can be purchased as an individual or family plan. You can enroll directly through a private insurance company, or through the Affordable Care Act (ACA) Marketplace. You will need to pay close attention to the implant coverage included in the plan. Some plans do not include benefits for them and others have strict requirements on when they are allowed. Also, keep in mind that there are annual limits that a plan will pay and implants often fall outside of that limit.
Dental savings plans
Dental discounts plans are also offered by private companies and are a great way to get reduced fees on services. In exchange for a premium, you will have discounted prices on all of your dental services, not just implants. Outside of enrolling in a discount plan, your dentist may offer discounts for pre-paying for services or if you use cash instead of a credit card.
If you live near a dental school, you may be able to schedule an appointment with a dental student who places implants. They are supervised by more knowledgeable dental providers, so you can rest assured your treatment will be done correctly. Since they are students and the appointments are often longer, they offer their patients significant discounts on treatment.
Why doesn’t Medicaid typically cover dental implants?
Medicaid is designed to provide basic healthcare needs to low-income people. Implants are not considered a basic need as there are other more affordable ways to replace missing teeth. If the Medicaid program were to include implants in their benefits, a large amount of funds would need to be taken from other aspects of the program.
Is Medicaid dental implant coverage the same in all states?
Generally speaking, yes, Medicaid’s dental implant coverage is the same across the country. However, there are significant differences in what kind of dental coverage is provided for adults in each state. Check your state resources to learn more about what benefits are available in your state.