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So you’ve lost a tooth and would like to have the lost tooth replaced, only to find that it typically costs between $3,000 to $4,000 dollars to have it replaced! You don’t have that kind of money, which begs the question, “Does Medicaid cover dental implants”?
Generally speaking, Medicaid does not typically cover dental care, and especially not cosmetic procedures such as dental implants. However, there are a few instances where Medicaid will cover a dental procedure. These are cases where you’ll need the procedure in order to maintain good general health.
When will Medicaid cover a dental procedure?
Medicaid provides coverage if you need to have dental work done in preparation for a medically necessary procedure.
An example of this is if you are in a car accident involving your jaw or face. If you need surgery that involves the removal of some of your teeth such as to prepare you for jaw reconstruction surgery, then Medicaid will cover the removal of the teeth.
If you’re worried about covering up lost teeth, then you might want to consider alternatives to dental implants that Medicaid will cover.
Medicaid will cover a bridge or dentures to replace lost teeth rather than dental implants. This is because dental implants cost substantially more than dentures, and Medicaid may deem that such expenditure is unnecessary if the same outcome can be achieved with dentures.
Age affects whether your Medicaid coverage for dental care
Medicaid coverage is different for patients under the age of 21 and patients over the age of 21.
Dental Coverage for Patients Under 21
Any person who is under the age of 21 who is also Medicaid eligible is also required to receive Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits. EPSDT benefits will aid in early diagnosis and prevention of dental issues by providing access to the necessary dental services.
If the EPSDT leads to you needing some form of dental implants, then Medicaid will cover the EPSDT portion.
Dental Coverage for Patients Over 21
Whether or not Medicaid will cover dental implants for patients over the age of 21 will depend on the state you live in. It will depend on the individual state’s determination. The state can decide what will and will not be covered in terms of dental care, including implants.
There are multiple stages involved in the dental implant process. For this reason, it is possible that Medicaid may pay for certain early stages in the process without paying for the entire procedure.
Still, some financial assistance is better than none. Some examples of steps in the procedure include:
- CAT scans, which are used to measure bone density and determine structural anomalies.
- Tooth extractions resulting from a health condition, disease, or an accident.
- Bone grafting following an accident, or relating to a medical disease.
- Surgical placement of the implant body into the bone of the jaw.
How to get special consideration for your dental implants.
If you’re certain that you need dental implants, then you might be able to request special consideration from Medicaid. Essentially you have to prove that your procedure is medically necessary rather than elective or cosmetic in nature.
It will be an uphill battle, but to get prior approval from your Medicaid provider, you will need to provide supporting documentation from your physician and/or dentist. Examples of supporting documents include:
- An explanation of how the implants will benefit the patient’s medical condition.
- A letter from the patient’s physician or dentist explaining why implants are necessary. The letter should explain why other covered functional alternatives for prosthetic replacement will not correct the present dental condition, necessitating the implant procedure.
- A complete treatment plan.
- Full mouth radiographs or a diagnostic panorex including periapical. A panorex is a special two-dimensional x-ray used specifically for the dental field that displays the upper and lower teeth and both jaws in the same film for a complete picture.
- The physician’s documentation should also include a list of all conditions presently being treated as well as all medications the patient is currently taking.
Additional documentation may be requested by Medicaid as well. The more documentation provided by physicians and dentists, the more likely your Medicaid provider will be to approve the procedure.
Why Doesn’t Medicaid Typically Cover Dental Implants?
Medicaid is designed to help low-income families by making it possible for them to afford medical costs by providing them with health care coverage.
Dental implants are considered to be cosmetic, elective and its cost is typically higher compared to other types of dental procedures. Therefore dental implants typically fall outside the scope of Medicaid’s purpose.
The short answer to the question about whether Medicaid covers dental implants is no. Medicaid does not provide coverage for dental implants is because Medicaid only covers essential treatment. Dental implants are typically considered cosmetic and are accordingly not covered.
However, if you can provide enough evidence to your Medicaid provider that your dental implants are essential or are a medical procedure that is necessary to maintain your general health, then you might be able to have the procedure covered. You’re not likely to succeed, however.
If you’re still in doubt, consult your dental professional. They will be able to provide you with more information if you have specific questions. If you are covered by Medicaid, contact your provider to learn what dental procedures are covered in your area.
Alternatively, you can also consider a bridge or dentures as an alternative. These are usually covered under Medicaid if you can prove they are medically necessary.