Get the Facts About Medicaid and Dental Insurance

Medicaid plays a vital role in providing health care coverage for millions of American families. But when it comes to oral health, the connection between Medicaid and dental benefits can be confusing. Whether you’ve recently enrolled in Medicaid, are exploring coverage for your children, or simply want to understand why certain procedures are (or aren’t) covered, knowing how Medicaid works with dental care is essential.

Understanding How Medicaid and Dental Benefits Work Together

You may wonder if you need dental coverage if you’re on Medicaid. The answer depends on the type of dental care you expect to need. Medicaid does include dental benefits, but the level of coverage varies.

Medicaid Dental Coverage for Children

For children in Pennsylvania, Medicaid dental benefits are comprehensive. Under federal law, Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires states to provide no-cost dental services for anyone under age 21.

In Pennsylvania, children covered by Medicaid can receive these benefits:

• Routine exams and cleanings.
• X-rays.
• Fluoride treatments.
• Sealants.
• Fillings.
• Tooth extractions.
• Other medically necessary treatments.

This broad scope ensures that children get preventive and restorative care without cost barriers. For families, Medicaid serves as an essential resource that helps protect children’s oral health and long-term well-being.

Medicaid Dental Coverage for Adults

Adult coverage looks very different. While Medicaid does include dental benefits for adults in Pennsylvania, they are more limited. Adults are generally eligible for:

• Routine exams and cleanings.
• X-rays.
• Basic restorative services (such as fillings).
• Extractions.

However, certain treatments—like root canals, dentures, crowns, or periodontal therapy—may be covered only when deemed medically necessary or may not be covered at all. This is where many individuals feel gaps in their coverage, prompting them to seek supplemental dental insurance for Medicaid.

In short, Medicaid covers the basics, but adults may still need additional dental coverage depending on their oral health needs.

The Importance of Access to Oral Care

Although dental care was built into Medicaid early for children because lawmakers recognized how critical oral health is for a child’s overall well-being, for adults, dental coverage only emerged later as a discretionary benefit when states began acknowledging the health and cost impacts of untreated dental disease.

A recent ADA report underscores just how essential oral health care is to overall health. The study found that if adult dental benefits were removed from Medicaid, the ripple effects would be significant—leading to nearly $1.9 billion in added health care costs across the U.S. in just one year, largely from preventable emergency department visits and untreated dental disease.

As discussions take place around potential changes to federal Medicaid funding, these findings highlight the critical role dental benefits play. Any updates to federal policy will be closely monitored to understand how they may affect access to oral health care in the future.

In the meantime, it’s important to remember that Medicaid’s dental benefits, while not perfect, help ensure that individuals and families can receive essential care before problems escalate.

Dental Insurance/Medicaid Options

In Pennsylvania and many other states, adults and children enrolled in Medicaid often receive their benefits through managed care organizations (MCOs). These plans contract with the state and include dental benefits directly. No separate dental insurance plan is required.

Most people get dental coverage by:

• Checking the dental benefits included in their specific Medicaid MCO.
• Using the MCO’s provider directory.
• Visiting any dentist who accepts that Medicaid plan.

In PA, common Medicaid MCOs include UPMC for You, Keystone First, PA Health & Wellness, Aetna Better Health, and others. Each plan has its own policies, covered services, and provider network. That means your dental benefits may differ from someone else’s, even though both of you are enrolled in Medicaid.

When navigating dental insurance for Medicaid, it’s essential to:

1. Review your plan’s dental handbook for specific covered procedures.
2. Check preauthorization requirements.
3. Verify provider participation. Not all dentists accept every Medicaid plan.

At Penn Dental Medicine, our team can help you understand your plan and determine which services are covered.

Questions About Medicaid and Dental Coverage? We Can Help

Penn Dental Medicine is proud to serve Medicaid patients and expand access to high-quality, affordable care. As a teaching clinic, we offer comprehensive dental treatments at reduced fees, making advanced care more accessible for patients whose Medicaid dental insurance doesn’t cover certain procedures.

If you’re navigating Medicaid and dental coverage and need care, Penn Dental Medicine is here to help. Our teaching clinic provides top treatment at reduced costs, and we proudly accept many Medicaid plans. Whether you need preventive care, restorative treatment, or guidance on understanding your benefits, our team is ready to support you. You can also read more about Medicaid and dental benefits in this article.

Call us today at 215-898-8965 or schedule an appointment online to get started on a healthier smile.