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.
Medicaid is a tax-funded government-run program designed to help low-income families and individuals with medical costs . 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 . 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.
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 .
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.
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.
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.
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.
If Medicaid won’t cover your dental implants, here are some alternative ways to pay for your treatment:
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 . 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 .
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.