Dental health is an important part of our physical well-being. However, when it comes to government-run healthcare programs, dental coverage is often stripped down and insubstantial. We examine Medicaid and Medicare dental coverage, exploring the strengths and shortcomings of each:
Medicare and Medicaid are federal programs aimed at providing low-income individuals with healthcare coverage. So, what’s the difference between the two?
If you’re eligible for both Medicare and Medicaid, you can use them together. This means that you’ll end up with a strong level of healthcare coverage across the board.
Most dental procedures and coverage for routine dental care, such as exams, fillings, cleaning, and tooth extractions, are not covered by Medicare. There are some exceptions. If you need dental care to perform a non-dental procedure, or if you need to be hospitalized following a dental procedure, Medicare will cover the cost. For example:
People with Medicare Advantage plans (Part C) may be able to receive routine dental care as part of their coverage. From x-rays to tooth extractions, Medicare Advantage coverage tends to be much more extensive than Part A and B. Of course, coverage varies between different plans, so it’s always best to check the specifics before you go in for treatment.
If the dental procedures you need aren’t covered by Medicare, they may be covered by Medicaid. States are required by law to provide dental coverage for children, although coverage for adults is an optional service, and therefore not provided by all states. Emergency dental care is normally available, but overall, Medicaid dental coverage for adults is not comprehensive. If possible, you should consider taking out a dental insurance plan instead. If you’re unsure about what dental coverage is provided by your state under Medicaid, it might be worth checking online.
Medicaid’s child health program is referred to as the EPSDT (Early and Periodic Screening, Diagnostic and Treatment). It’s mandatory and must be provided by the state. If the screening uncovers something which requires treatment, the state is required to treat the condition, regardless of whether this treatment is covered under the state’s Medicaid plan.
Dental services must be provided at intervals that are in accordance with proper dental practice. These intervals are determined by the state. Although oral screening is sometimes part of a general physical exam, it doesn’t substitute for a comprehensive dental examination. So, what services are provided for children? At a minimum, Medicaid for children usually covers:
Another way that children can receive dental coverage through Medicaid is CHIP (Children’s Health Insurance Program[JS1] ), which is available for children whose family income is above Medicaid level, but not high enough for any other forms of health insurance. Coverage is available from private healthcare providers, although not all dentists participate in the program. You can find details on participating dentists from your local healthcare department.
Although some dental coverage is available via Medicare and Medicaid, it’s not particularly extensive. Better dental coverage options are available, but for low-income households, it can be a good means of supplementing your dental care.
Want to find Medicare and Medicaid dentists in your local area? Call 1-800-DENTIST today!
[JS1]Link to program