Medicaid is a program that is funded by both the states and the federal government. The program provides healthcare benefits to low-income families, pregnant women, the elderly, and individuals with disabilities. Each state administers their own Medicaid program according to the federal guidelines and requirements.
According to the Center for Medicare and Medicaid Services (CMS), nearly 75 million Americans are enrolled in the Medicaid program. There are approximately 23 million Americans who have complete dentures. Dentures are a common method used to replace missing teeth, and since so many people benefit from Medicaid, participants often ask if dentures are included in their coverage.
Medicaid coverage for dentures
Different from state to state
Since each state administers their own Medicaid program, denture coverage varies from one state to another. This is true for dentures as well as dental benefits in general. Most states include at least emergency care benefits, but there is no set requirement for adults on Medicaid. This is different from for children on Medicaid, who are guaranteed certain dental benefits.
There are currently ten states that provide coverage for dentures: Alaska, Idaho, Louisiana, Michigan, Montana, Nevada, New York, North Carolina, North Dakota, and South Dakota. These states all have their own limitations and requirements.
Dedicated to selected dentures types
You may also find that if your state’s Medicaid program does allow for denture coverage, there are limitations on the type of appliance that includes. Partial dentures and complete dentures are both included in the benefits, but they may be limited to one set every ten years - some are even limited to once per lifetime. This could be a problem for someone who starts with a partial denture and then needs other teeth replaced before the ten years have lapsed.
Your dentist might discuss the option of an implant-retained denture. These appliances snap onto the implants that are placed in the jaw, which gives them a more stable fit. Even if your Medicaid program pays for a traditional denture, they may not include coverage for one that includes implants.
Provided by only certain specialists
Yet another requirement you’ll need to determine is if the Medicaid program in your state only provides denture coverage if you get the denture from a certain type of dental provider. Both general dentists and prosthodontists can fabricate dentures. Individuals on Medicaid will also need to find a dental provider who accepts Medicaid insurance.
Alternatives to Medicaid dentures coverage
If you live in a state that does not provide denture coverage as part of their Medicaid benefits, there are other ways to get financial assistance.
One way is to enroll in a dental insurance plan. Private insurance companies offer individual or family plans and often include denture coverage. The plans will vary in their premiums, deductibles, and coinsurance amounts, so be sure to read the policy summary to find out the details of your plan.
Another great option to get affordable dental care is through a dental school. Dental programs need patients for their students to care for, and they often have lower prices because they are learning facilities. Be prepared to spend more time at each appointment, but you can save hundreds by going to a dental school.
Lastly, check with your current dental provider’s office about any senior discounts they might offer. If they don’t have a senior discount, they might give you a reduced fee for either pre-paying for services or paying with cash or check. (It will save them a credit card processing fee.) Many dental practices also use third-party financing, sometimes with 0% interest for a short period of time.
How much do dentures cost with Medicaid?
The cost of dentures with Medicaid will depend largely on the state you live in. Medicaid dictates the prices for dental services, including what the individual pays. Providers who are not contracted with Medicaid do not have to accept the program’s fees.
Are Medicaid dentures benefits the same in all states?
Medicaid denture benefits vary significantly from one state to the next. There are currently ten states that include denture benefits in the program. The annual maximums and frequencies are all different in those ten states.
Who is eligible for Medicaid dentures?
Any person on Medicaid is eligible for dentures. Individuals and families with low incomes, pregnant women, the elderly, and those with certain disabilities are all eligible for Medicaid. The specific income limits are set by the federal government and are adjusted each year with the cost of living.