Does nc medicaid cover dental for adults 2022

When you have missing teeth, there’s only one thing that can restore your smile, confidence, and the quality of your life—dental implants. However, dental implant procedures are expensive, and you don’t want to miss out on dental coverage if you are eligible.

In most cases, Medicaid won’t cover the cost of dental implants, but there are a couple of ways if the procedure is deemed medically necessary or it falls under health insurance.

Key Takeaways: Does Medicaid Cover Dental Implants?

• Medicaid is a tax-funded government-run program designed to help low-income families and individuals with medical costs [1]. While it is a federal program, each state sets its own rules as to what’s included in the coverage.

• In most cases, Medicaid won’t cover dental implants as the program doesn’t recognize the procedure as a medical necessity [2]. Instead, Medicaid classifies the dental implant procedure as a cosmetic one that doesn’t affect your overall health or wellbeing.

• In some states, Medicaid doesn’t include any dental care coverage. However, there are exceptions and cases when Medicaid will pay for dental correction procedures, including dental implants. These procedures need to be medically necessary to fix other health issues.

Dental implants are not among the basic procedures Medicaid routinely pays for. For the program to cover the procedure’s cost, it must be deemed medically necessary due to a medical state.

Medicaid may also cover implants for eligible seniors on Advantage plans who need them due to dental health issues like decay or periodontal disease.

When Does Medicaid Cover Dental Implants?

Medicaid can cover the entire dental implant process when it acts as health insurance. The program would pay for all dental procedures to preserve jaw bone structure if the problem originated elsewhere in the body. That means that your missing tooth or teeth must result from other medical conditions like diabetes or osteoporosis.

You’ll need detailed paperwork explaining why implants are the only viable option for Medicaid to pay for dental implants. Your doctor and dentist must also send a comprehensive treatment plan to Medicaid for special consideration. You may still be denied.

Medicaid recipients under 21 can have a part of their dental implants covered. They have a right to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). If they need the implants under EPSDT, they can have Medicaid pay for the dental procedures [3]. 

There are certain instances when Medicaid will cover tooth repair and other dental work, including some tooth implants when acting as dental coverage. What dental treatments Medicaid covers depends on the state you live in.

• Partial or full dentures – Medicaid can cover dentures in thirty-three states as part of its dental care program. If you need to restore your ability to chew, the rule of the least costly treatment means that it is likely you will be offered dentures rather than dental implants.
• Oral surgery – Twenty-six states will cover surgical procedures as part of dental wellbeing maintenance. That includes early-stage tooth implant treatments like cone beam computed tomography (CT), tooth extractions, bone grafting, and sinus lift.
• Crowns – If you lose your permanent teeth, you may get some help with crowns and bridges from twenty-six states. The insurance may pay for the implant frame (crown or bridge) but not the denture fitting or installation procedure. 

Many people also ask “Does Medicaid cover braces?” Like with dental implants, Medicaid will cover different types of braces only if they are deemed medically necessary. Byte would be a cheaper alternative if you just want to fix crooked teeth. Check out our Byte review if you are interested in aligning your teeth without braces.

What Makes Dental Implants Medically Necessary?

Dental implants are considered medically necessary when they are an effective treatment to fix the function of the teeth, like chewing. They would also have to be the least costly treatment. In these cases, teeth loss would need to happen due to medical conditions that started in the body, like diabetes, or severe dental problems, like periodontal disease.

How to Get Medicaid to Pay for Dental Implants

You need to prove that dental implants are medically necessary. Send the detailed paperwork done by your physician and dentist, recommending implants as the only effective option for your condition. You should also include a detailed treatment plan from your dentist.

How to Pay for Dental Implants Without Medicaid

If Medicaid won’t cover your dental implants, here are some alternative ways to pay for your treatment:

• Cosmetic Dentistry Grant – If you can’t get Medicaid to pay for your dental implants, you can apply for a Cosmetic Dentistry Grant (CDG). These are federal grants for cosmetic dental work. To be accepted, you need documentation proving you have good oral health to ensure the procedure is successful.
• Dental insurance – There are individual and family insurance plans. You can get the best cheap dental insurance from a private company or the Affordable Care Act Marketplace. Pay close attention to their implant clauses and annual limits, as dental implants can fall outside the limits.
• Dental schools – The cheapest way to get a dental implant is to get it from a student at a dental school. Students work under the supervision of senior dental professionals, so you can rest assured they’ll do a good job. The prices of dental work at dental schools are significantly lower.

FAQ

Below we answer some of the common questions about Medicaid and dental implants. 

Medicare doesn’t provide coverage for most dental care, dental implants included. It doesn’t even cover basic procedures like tooth extraction, fillings, or cleanings. Advantage plans cover most of these procedures.

Indiana offers limited Medicaid dental coverage. That means the program doesn’t cover elective procedures and will only cover your dental implants if they are medically necessary.

Ohio provides its citizens with extensive Medicaid coverage for dental care. That means you can use Medicaid coverage for checkups, cleanings, fillings, extractions, medical/dental surgical procedures, and root canals. You can only get coverage for implants if the procedure is medically necessary.

Coverage in Virginia is reserved for emergencies only. Medicaid will not pay for elective treatments like implants. You are entitled to a regular dental checkup and cleaning every six months, and three total dentist visits a year.

Louisiana has limited coverage for dental care. That means you can only get an implant if it’s medically necessary.

Colorado offers limited dental care coverage under the Medicaid program. Implants usually aren’t covered unless they are medically necessary.

Medicare only allows for implants if they are medically necessary in New York [4]. That means that you can only get them to fix the function of your teeth after it’s been destroyed by a disease like diabetes.

North Carolina has extensive coverage for dental treatments, which includes preventive, periodontal, dentures, and oral surgery services. It doesn’t cover orthodontia and implants unless it’s due to medical necessity [5].

Conclusion

Considering one dental implant can cost from $1000–$3000, any help from your Medicaid provider would go a long way. However, Medicaid rarely covers dental implants for adults. The only exceptions are when the procedure is deemed medically necessary and the least costly option available.

Does North Carolina Medicaid cover dental for adults?

What dental services are covered by Medicaid?

What does NC Medicaid cover?

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