PA Medicaid Dental Benefits (Patient’s Complete Guide)

Monday, March 1, 2021
PA Medicaid Dental Benefits (Patient’s Complete Guide)

Optimal oral health is essential to your overall health and wellbeing. Routine dental care—including regular visits to the dentist—helps ensure that your dental health remains in top condition. But, some people may avoid going to the dentist because of cost concerns.

Female staff wearing a mask and a safety visorAt Penn Dental Medicine, we understand concerns involving affordable dental care. For this reason, we help patients explore payment options, including how to best take advantage of their PA Medicaid dental benefits. Our goal is to help you understand how your dental benefits work, and exactly what will be covered.

In an effort to help you better understand what type of dental services are covered by PA Medicaid, we’ve put together this helpful guide.

What does Medicaid Cover in PA?

The way Medicaid or Medical Assistance (MA) in Pennsylvania works in terms of dental benefits is based on eligibility. The dental services available to you will depend on certain criteria such as:

  • Your eligibility category
  • Your age
  • Your need (often, those in lower-income areas are eligible—see below)

More specifically, PA Medicaid Eligibility guidelines include:

  • Adults between the ages of 19 and 64 with an income below 133% of the Federal Income Poverty Guidelines (FPIG)
  • Families with children younger than age 21
  • Persons with special medical assistance conditions
  • Family Income based on:
    • Household size in comparison to income limits (including wages, interest, social security, spouse income, dividends, veteran’s benefits, and pensions)
    • Age factors
    • Disability factors

Does Medicaid Pay for Dentist Visits?

A male student doctor performs dental services for a male patient.Depending on your eligibility, Medicaid may cover certain dental services. Children, for example, are eligible for:

Children may be eligible for additional dental treatments (depending on their specific Medicaid plan and benefit limit).

Adult Medicaid dental benefits cover a minimum for:

Medicaid coverage may include additional dental services for adults. The best way to find out exact eligibility and coverage for dental options is to reach out to your local county assistance office. If you do not yet have Medicaid, you will need to apply. After applying, you should learn what dental care services you are eligible for.

Making Dental Health Care Less Puzzling, and Easier to Understand

two student dentist perform dental work on a patient who has dental anxietyAt PDM, we understand the frustrations that can come with trying to figure out Medicaid insurance or other types of payment. We work with lower-income areas and underserved populations to help make comprehensive dental care available—and easier to understand. This includes ensuring that each patient is advised of the estimated cost of their recommended treatment. And, our student dentists are dedicated to helping answer any questions you may have about treatment costs prior to your dental service.

In addition to accepting direct payments from most dental insurance plans, PDM accepts all Medicaid plans offered to residents of Southeastern Pennsylvania.

And, in an effort to make sure you receive the dental care you need and deserve, we’d like to provide you a free resource to help you find affordable dental care: Dental Work Without the Stress eBook. This complimentary guide will help you figure out how to pay for cavity and tooth infection treatment, and other important dental services.

But, Is It Safe to Visit the Dentist?

While the COVID-19 vaccine provides some hope of reducing the spread of the coronavirus, some dental patients are still curious about dental safety. How safe is it right now to go to the dentist? According to the American Dental Association (ADA), it’s not only safe to visit the dentist—it’s encouraged!

Because routine dental care is crucial to promoting positive oral health and overall health, it’s considered an essential service and is therefore recommended.

Plus, since PDM operates in conjunction with the University of Pennsylvania School of Dental Medicine, we remain at the forefront of the latest research and practices in dentistry—including how to maximize safety (we’ve even established some of the safety standards used throughout the dental industry!)

Next Steps

If you’d like to learn more about what dental procedures are covered as part of your PA Medicaid dental benefits, call the PDM office at 215-898-8965 to schedule your appointment. Or, click here to contact us for questions.

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