What is Medicaid?
Don’t confuse Medicaid with Medicare. Both are government health programs, but they differ in who they are for, the income levels involved, and the cover they provide.
Medicaid is:
- A state health program that provides medical care to people on low incomes and to low-income families. It can cover things Medicare does not, including nursing home care and some dental work.
- Funded by both the federal government and state governments. Services, coverage and eligibility are decided by each state, which is why what you get under Medicaid varies so much from one state to another.
- Limited on adult dental care in many states. Some states pay only for emergency dental procedures, while others provide comprehensive dental care.
What you can get from Medicaid depends on the state you live in.
Medicaid for Children
States are required to provide dental care to all children enrolled in the program. Children are entitled to a basic oral screening as part of a physical exam, and to a proper dental check-up when one is needed.
The basic dental care that has to be provided to children includes pain relief, restoration of teeth, and maintenance of oral health. If a screening finds a serious condition, the state is required to treat it.
Medicaid for Adults
Nearly all medical care for children under Medicaid is required by law. For adults, states decide whether the benefits are extended at all, and if so how far they go. That is why Medicaid coverage differs so much across the country.
If you are planning to enroll, read up on the Medicaid package in your own state first. Some states cover almost all dental work, while many cover only emergency treatment.
Dental Work Covered by Medicaid
As noted above, Medicaid covers emergency dental care in almost all states.
That includes emergency extractions, pain relief, and treatment for infections or bleeding gums. A dental emergency caused by an injury, or by an illness elsewhere in the body, also counts as emergency dental work.
In states that go further, the dental work available under Medicaid can include:
Basic care – routine dental care, covered in most states, although what counts as basic varies.
Preventive care – regular visits to the dentist, check-ups, cleaning, X-rays and sealants.
Crowns – covered in some states, usually only the least costly type of crown.
Braces – covered where they are needed because of a disease or an injury.
Periodontal treatment – bone grafting and gingivoplasty, covered in a smaller number of states.
Root canal – covered in some states, often only up to a set dollar limit or on specific teeth.
Oral surgery – corrective jaw surgery and wisdom tooth extraction, where the state includes oral surgery.
Adult dental benefits change from state to state, and states revise them from time to time. Check the current rules for your own state rather than relying on a general list.
The Coverage Gap
A large group of people get no help at all with the cost of dental work. This is known as the coverage gap.
Many states have expanded their Medicaid coverage to include more people who need it but who missed out under the previous cut-off of 133% of the federal poverty level. Some states have adopted the expansion and some have not. That creates a gap: people who can afford it pay for treatment themselves, people below the cut-off are covered by Medicaid, and the group in the middle is left to manage on its own. These are people who are not poor enough for Medicaid and not well off enough to pay for regular treatment.
Add in the people who live in states that pay for nothing beyond emergency treatment, and the group is larger still.
The unfortunate result is that many of them stop looking after their oral health and avoid treatment simply because of what it costs.
Dental Plans As An Alternative, Or Supplement To Medicaid
There are still options for people in the coverage gap. Various dental plans exist for people who are not covered by government-funded insurance, so they can look after their oral health without worrying about the full price of dental fees.
Dental discount plans, also called dental savings plans, take some of the weight off dental charges. That makes it easier to keep up with regular check-ups.
- Dental plans are straightforward and there is no lengthy claims process.
- You enroll in a plan, visit a dentist who accepts it, and pay the discounted rate at the time of treatment.
- Discounts typically range from 10% to 60%, depending on the complexity of the work. You pay an annual membership fee.
Dental plans are one answer for people in the coverage gap. You can also take out a dental plan while you are on Medicaid, and use it to supplement Medicaid in states that pay for nothing beyond emergency procedures. A plan can save you hundreds of dollars a year, and it means you are less likely to skip a visit to the dentist because of the cost.
Here at Dental Plan Provider we can help you find affordable dental plans in your area and compare them, so you can pick the one best suited to your needs.
