Medicaid and Dental Benefits for Children and Adults. Public and Private Coverage of Dental Services.

Medicaid Dental Coverage Services and Options

Oral health in America for low-income individuals has always been a widespread concern. Individuals with low incomes which is below the federal poverty level are more prone to high cavity levels because dental care is not always available. Medicaid and dental work is a requirement for children (under age 21) who need dental care. Unfortunately, there are no minimum coverage requirements for adults. Medicaid is a low income or a free health insurance program and is supported or funded by the federal government and state governments. Under its cover are children, the disabled, and older adults.

Does Medicaid Help Cover Dental?

Medicaid does help cover dental benefits for adults when there is a medical emergency or medically necessary dental care that is formed due to diseases or illnesses that causes dental health problems. The federal leg of Medicaid has no requirements to cover any dental benefits for adults under the Medicaid plan. This means that each state is left to determine whether to provide Medicaid coverage based on each case. Leaving adult dental care in the hands of each state means that they make the determination to reduce benefits or even eliminate benefits based on their budgets.

What About For Children?

However, it is mandatory under federal programs like the Early and Periodic Screening, Diagnostic, and Treatment program or EPSDT, as well as the Children‘s Health Insurance Program or CHIP, that children are required to receive comprehensive dental services.

Medicaid Dental Coverage for Adults

Medicaid and dental work are provided in 32 states if individuals receive SSI or Supplemental Security Income. Whether the percentage is covering dental benefits for adults patients, is determined by the state, thus eligibility varies. Talking about Medicaid coverage for emergency dental care, the federal and state government identifies this category that involves excessive gum bleeding, oral infections, or harmful injuries to the gums and to the teeth. We understand that Medicaid does not provide the best coverage for adults over 21. However, adults are covered if there are any emergencies or medically necessary dental care. As previously stated each state mandates their own benefits and coverage.

State Medicaid Benefits

Let’s look at what certain states provide in dental benefits or adults under certain dental categories:

  • Dental Implants: Implants are an expensive tooth replacement solution. It is rare that Medicaid fully covers dental implant costs. Dental implants are categorized as an elective, meaning it is not included in all 32 states.
  • Dental Crowns: Crowns are what dentists call a “cap” that covers a bad tooth to help repair its size, shape, strength, and better health. Yes, Medicaid does cover dental crowns but only in 26 states out of the 32.
  • Orthodontal Braces: Yes, Medicaid covers orthodontic braces for adults but only when there is an emergency of medical necessity in all states. The braces are paid for when the condition consists of an oral injury, severe sleep apnea conditions, unhealthy TMJ conditions, or a disease is impacting someone’s health.
  • Preventive oral care: Medicaid provides oral care in 27 states as part of the state’s preventive or is part of a health wellness care treatment. Each Medicaid-sponsored state coverage helps low-income individuals and families prevent periodontal diseases, cavities, teeth enamel wear and other conditions that could cause the loss of teeth.
  • Periodontal care: Medicaid pays for periodontal care in only 18 states. Periodontal care like preventive oral care is all about keeping gums and teeth healthy.
  • Root Canals: Only 26 states cover root canal treatments under Medicaid. Endodontists are dental specialists that treat teeth pulp conditions.
  • Oral Surgery: Only 24 states under Medicaid covers this procedure.
  • Pregnancy Care: Medicaid and dental work in pregnancy care is a mandatory coverage. Hormonal changes affect a woman’s total body health including their teeth and gums. Therefore, federal and state coverage under Medicaid is very important. Of the 32 states (31 states + Washington, DC) that feature Medicaid benefits are working to expand dental plans for Medicaid adult populations.

Dentists and Medicaid

One of the most important factors in Medicaid coverage is finding dentists who will accept the plan for adult coverage. The reason for this is that because the government typically offers very low-cost recovery rates which means that dentists are not reimbursed as much as private insurance. Dental practices around the U.S. are coordinating together to ask the state and the government for more funding to treat adult patients. State-sponsored Medicaid managed dental care is slowly being negotiated separately with varying insurance plans to service for Medicaid adult patients.

Public and Private Coverage of Dental Services

Even though the Medicaid program doesn’t provide full dental coverage for adults, the U.S. Department of Health and Human Services is supportive in advancing the oral health and well-being of its citizens. The Health and Human Services Oral Health Strategic Framework is a program that purposely keeps ongoing oral health community and organizational dental programs for all ages. There are many public and private services that help the population find oral dental care because healthy dental treatments do affect our lives. Poor dental health can give you heart problems, strokes, dementia, respiratory issues, and unfortunately much more. Taking care of your gums and teeth is a preventable treatment that states and federal government private and public programs support.

Private Coverage of Dental Services

There are a variety of private dental insurance plans that provide basic and major dental care for a low manageable budget cost. Many individuals receive dental insurance benefits through their workplace or group coverage dental plans and programs like elderly association plans, military programs, and more. Private dental coverage is a separate plan from a typical health insurance plan. These plans provide preventive treatments for cleaning and fluoride solutions. Many state private insurance plans can be found featuring no deductibles or a lengthy waiting period.

Additional Benefits For Private Dental Insurance

Additional basic benefit services under private dental insurance coverage include treatments for fillings, root canals, braces or retainers, and more. There are no annual maximums to meet and you can set your own co-payment costs which helps your budget. Private dental insurance plans identify upfront the type of dental procedure you need and exactly what it will cost. Knowing what your payments are helping give families and individuals a peace of mind. Using private coverage dental plans, they take the fuss out of submitting claims which are done by the provider. Several private dental insurance service plans do have in-network restrictions, but they do not carry any age restrictions. Everyone in the family is eligible under private dental insurance plans.

Public Coverage of Dental Service

The best public dental insurance coverage options afforded to rural citizens or families and individuals who need dental care that is not within their pocketbooks is supplemented by several community programs. For example, the Bureau of Primary Health Care which is sponsored under the parent department of Health Resources and Services Administration supports public dental insurance community health centers that provide free or vastly reduced public dental insurance health services. The Bureau of Primary Health Care centers is featured throughout U.S. Communities under various names.


Many of the community-based dental and medical care centers are great teledentistry models. There is vital teledentistry communication between dentists, hygienists, and dental students. Citizens are treated to teledentistry technology where their oral conditions are caught on image producing machines and are transmitted to oral health specialists. Community-based dental centers are helping thousands of patients that would ordinarily not go to a dentist for help.

Dental Schools

Other public dental insurance style coverage and dental service options are in the use of dental schools. Accredited dental education programs sponsored by the ADA (American Dental Association) allows qualified dental students to work on basic treatments for the public. The students are supervised by licensed teachers and the school-public connection is proving to work very well in keeping the public’s oral health good.

Dental Foundations

Other local dental care options sprinkled throughout states include programs funded by dental foundations. Licensed dentists take the time to visit schools and low-income neighborhoods to treat adults and children. They treat people with all sorts of dental issues, but basically, the dentists clean and x-ray gums and teeth. If there is a severe oral problem, the dentists bring the situation to the local state programs.

Dental Options for Adults

Dental benefits will vary between private and public dental plans and varying dental programs. Public and private dental plans are designed to provide preventive care before something bad goes awry. Medicaid eligibility for low-income adults, its coverage for dental benefits, dental providers who will continue to work in the program, and the vital health importance of preventive dental care are issues that low-income adults are faced with. All the factors go a long way in managing dental care for low-income adults. Education is also given the adults who can’t afford dental visits or who do not have insurance. Regular checkups are encouraged so that they don’t wait until a sudden strike of pain sends them to a dental specialist.

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