Does Medicaid Cover Dental Implants? – Overview
The topic of Medicaid’s dental coverage extent confuses patients looking for a way to pay for dental work.
So you’ve lost a tooth after an accident only to find the procedure costs four grand, and you might be wondering will Medicaid pay for my dental implants?
This mainly depends on the resolve of individual US States. Your State decides what will and will not be paid for about dental issues.
Guidelines govern Medicaid because it’s not a federal program but rather a State by State program.
Even in the US States where Medicaid pays for dental procedures, most dentists don’t accept this coverage because it has massive admin overheads and meager payment rates.
This affects patients from low-income families because they need dental implants the most.
What Are Dental Implants?
Dental implants are surgical procedures whereby a structure is placed into the jawbone to replace a portion of the missing tooth.
Once in place, a component known as an abutment connects the implant to the physical tooth.
The process of a dental implant majorly depends on the condition of your jawbone.
Initially, the dental surgeon must conduct an extensive assessment of your dental wellbeing via a dental examination to determine if an implant suits your needs.
Dental implants offer a welcome alternative to bridgework or dentures, which don’t always fit well.
Dental implants are also an option for patients who don’t have natural roots and cannot undergo entire tooth replacements.
Does Medicaid Cover Dental Implants for Patients Under 21 Years?
If you’re below 21 years and qualify for Medicaid, it’s specified that you must receive the EPSDT (Early Periodic Screening Diagnostic and Treatment) benefit.
If your EPSDT benefit deems it necessary for you to get some form of dental implants, then Medicaid will pay for the EPSDT portion.
The main aim of this benefit is to avert and offer early diagnosis and handling of medical conditions such as dental problems.
So if your physician confirms that you need dental implants to replace your permanent teeth, Medicaid may pay for the cost of this procedure.
However, there are some conditions given under the EPSDT benefit. It stipulates if a child has medical coverage, it must include:
1. Tooth repair.
2. Pain relief and infection treatment.
3. Dental wellbeing maintenance.
4. Any procedure that is deemed medically necessary by a physician.
If the above conditions aren’t met, it’s unlikely that Medicaid will pay for dental implants or any other implant options because they are regarded as elective treatments.
Medicaid is meant to cover basic procedures such as tooth removals and replacements with partial or full dentures.
Does Medicaid Cover Dental Implants for Patients Over 21 Years?
Whether or not Medicaid will pay for dental implants if you’re over 21 years will mainly depend on the US State you reside in.
Medicaid differs from State to State concerning the various kinds of dedicated dental procedures their programs may offer patients over 21 years.
The dental implant process has various stages, and it’s for this reason, that Medicaid may pay for some parts of the procedure.
Medicaid may only pay for the early stages of the procedure. Some of the stages of the dental implant procedure that Medicaid may pay for include:
1. CT (computed tomography) scans: This stage is meant to determine your bone structure and find any structural irregularities.
2. Tooth removal due to an accident, disease, or chronic health condition.
3. Bone grafting because of an accident, disease, or chronic health condition.
4. Surgical installation of the implant frame into the bone of your jaw.
5. However, it’s important to note that dental procedures for adults paid for by Medicaid are limited because not many dental practitioners in the US accept Medicaid coverage.
6. Studies show that only 38% of them accept Medicaid.
Why Doesn’t Medicaid Routinely Pay for Dental Implants?
Dental implants are a great treatment alternative, so why does Medicaid refuse to cover them?
Medicaid considers dental implants procedure to be cosmetic which is a bit inaccurate considering they help prevent movement of your teeth to remain healthy.
The real reason is that the cost of dental implants is typically higher when compared to other kinds of dental correction procedures.
It’s estimated that one dental implant could cost between 4000 to 6000 USD, and that’s why dental implant procedures fall outside the scope of Medicaid’s coverage.
It’s a bit confusing, considering Medicaid is designed to help low-income individuals afford medical costs.
Can You Get Special Consideration for Medicaid to Cover Your Dental Implants?
If you’re sure that you need to get dental implants, you might be able to obtain special consideration from Medicaid.
You have to provide evidence that the procedure is medically necessary rather than for cosmetic purposes.
It will be a long and daunting process, but to obtain prior consent from a Medicaid provider, you will have to provide supportive documents from a physician or dental practitioner.
Some of the documents you might need include:
1. An account of how dental implants will help your medical State.
2. An explanation from your physician or dental surgeon indicates why other functional alternatives for teeth replacement such as denture fitting or bridgework aren’t suited to your needs, thereby necessitating the dental implant procedure.
3. An entire mouth radiograph or analytical panorex. A panorex is an exclusive 2D (two-dimension) X-ray mainly used in dental procedures to show the State of the upper and lower teeth and the jaws in the same picture.
4. The entire dental implant procedure program.
If you have any other conditions being treated for, the physician should indicate them and also any medication you’re taking should be specified.
To sum it all up, there is no single correct answer as to whether Medicaid will cover your dental implants because there are many things that come into play.
For starters, it depends on the US State you presently live in and the rules they have made about dental care.
In addition, coverage changes over time as budgets rise and drop due to economic or political reasons