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Are Dentures Covered by Medicaid?

Are Dentures Covered by Medicaid?

Does Medicaid provide financial assistance for dentures? Unfortunately, the answer is a definite “maybe.”

The exact coverage provided by Medicaid depends on where you live, your specific dental needs and other factors. Navigating the Medicaid system, especially when related to dental care, can quickly become very confusing.

Here’s a complete guide to Medicaid dental coverage, including coverage for dentures. We’ll also take a look at other ways to potentially save on dentures, in case Medicaid doesn’t provide the coverage you need.

What is Medicaid?

Medicaid is a program which provides medical care for people with limited income and resources. The program is a joint venture between the federal government and each state. Medicaid provides free health insurance to over 74 million low-income and disabled individuals of all ages.

All states participate in Medicaid, and have done so since 1982, but participation isn’t actually mandated by the government. States have a lot of flexibility in what Medicaid services they want to offer residents.

What Dental Coverage is Provided by Medicaid?

The answer depends on where you live. No minimum amount of dental coverage is required. More than half of all states provide no dental coverage at all. Of the states which do provide dental coverage, most of it is limited to emergency care. Only a few states provide preventative care, and no states provide coverage for purely cosmetic procedures.

Note these coverage options only apply to people ages 21 and up. According to the Medicaid system, individuals under 21 are considered children, and are provided a variety of guaranteed dental care under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Care includes preventative, restorative and emergency services. In the relatively rare instances when children need dentures, they’ll have a lot more options through Medicaid than an adult.

Does Medicaid Provide Coverage for Dentures?

Rarely. Emergency dental treatment is usually limited to actions needed to stabilize a patient following an accident or dental emergency. Coverage focuses on the reduction or elimination of immediate pain, not on prevention or long-term care.

Even if your state does provide coverage for dentures, you might be disappointed with the results. For instance, Ohio covers dentures based on medical necessity. While a Medicaid recipient will likely be able to get a pair of dentures, maintenance and adjustments over time might be difficult. Plus, the quality of the dentures is usually very low.

How Important are Dentures?

Missing teeth affect your ability to eat, talk and fend off disease. Even just one missing tooth can create a space for cavity-causing bacteria to thrive. Plus, missing teeth can cause remaining teeth to shift position and become misaligned. You’ll want to replace missing teeth as soon as you can, and full or partial dentures are often an effective – and the most affordable – solution.

What if Medicaid Doesn’t Provide Coverage for My Dentures?

If the Medicaid coverage in your state doesn’t provide adequate coverage for the dentures you need, you might consider paying for them out-of-pocket. Unfortunately, this can be prohibitively expensive, especially considering many Medicaid recipients are on a limited income.

Dentures start around $300 for a very basic set but can increase in price to several thousand dollars. That doesn’t include any necessary dental visits for extractions, impressions necessary to create a custom-fitted pair of dentures, and other procedures. After you get your dentures, regular check-ups are necessary to ensure the dentures fit properly and no soft tissue disease develops.

One great option to help save on dentures is a dental discount plan. Often called an affordable alternative to dental insurance, a discount plan offers discounts directly at the dentist’s office. Members can save 15% to 60% on many different dental procedures often including costs related to dentures and denture maintenance. You can use your dental discount card as often as you like, which can help you save on both planned and unexpected dental expenses.

Navigating the Medicaid system can often be confusing. If your state doesn’t offer coverage for the dentures you need, options such as dental discount plans are available. Dentures help enhance both the health and appearance of your smile, and can be affordable even without Medicaid.

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