Does Medicaid Cover Wisdom Teeth Removal? – Overview
Medicaid pays for wisdom teeth removal in several states, but the extent of coverage and whether Medicaid pays for any other dental service varies from state to state.
Some State Medicaid plans only pay for emergency teeth removal procedures. States are not obliged to provide dental benefits to adults under Medicaid since dental benefits are optional.
Therefore, there are some states where Medicaid may pay for a benefit such as wisdom teeth removal for both kids and adults, and in some other states, it’s only kids who can have their wisdom teeth removal procedures paid for by Medicaid.
State Medicaid programs are required by federal laws to offer dental benefits to kids covered by the Medicaid program or the CHIP (Children’s Health Insurance Program).
Which Dental Benefits Are Included in Children’s Medicaid Plans?
State Medicaid programs are required by federal law to include a minimum of set dental benefits for kids that include:
- Teeth restoration.
- Relief of pain and infections.
- Maintenance of dental hygiene.
While wisdom teeth removals are not included as part of the minimum necessities, most state Medicaid programs have benefits that go above and beyond the least federal requirements.
This means they could pay for the cost of removing wisdom teeth for your child.
Also, adult Medicaid dental plans can help partially cover the cost of wisdom teeth extraction for your child.
However, you need to consult your local Medicaid office about any yearly confines on services and your deductibles before this happens.
Which Dental Benefits are Included in Adult Medicaid Plans?
There is no federal law that necessitates states Medicaid programs to offer dental benefits to adults. As per the CHCS (Center for Health Care Strategies), there are only four state Medicaid programs in America that don’t pay for dental services, and they include:
All other state Medicaid programs offer extensive, limited, or emergency dental benefits.
For instance, if a wisdom tooth is jammed and causing a great deal of discomfort, removal will be recognized as an emergency procedure and may be covered.
However, if the wisdom tooth is growing as it should be and not causing any discomfort, it’s unlikely that it will be regarded as an emergency, and as a result, it may not be covered.
As per the CHCS, the list of State Medicaid programs that offer extensive dental care include:
- District of Columbia
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
The list of State Medicaid programs that offer limited dental benefits include:
- South Carolina
- South Dakota
Finally, the list of State Medicaid programs that offer emergency-only dental benefits include:
- New Hampshire
- West Virginia
How Much Does It Cost to Remove Wisdom Teeth?
If your child’s wisdom teeth are just like any other teeth, they can be removed easily if need be.
However, if the wisdom teeth are unusual and come in sideways, they are what’s known as jammed or impacted wisdom teeth.
As a result, they are much harder to extract, making the process challenging and time-intensive thus raising the procedural costs.
Extracting a typical wisdom tooth using numbing medication (anesthetics) usually costs between 75 to 200 USD.
However, to remove a jammed or impacted wisdom tooth, the cost rises to between 225 and 600 USD per tooth plus the cost of the numbing agent.
As illustrated above, many states have limits in places for which dental services they can pay for within a certain period.
Also, some of these states have annual dollar limits ranging from 500 to 2,500 USD per annum.
What Efforts Have Been Made to Improve Dental Coverage Via Medicaid
Just like any other form of health coverage, dental coverage improves access to medical care.
Although federal laws do not mandate state Medicaid programs to offer adults dental coverage, most low-income persons get dental benefits via Medicaid.
Medicaid dental benefits vary state by state and from one year to the next, making it difficult for beneficiaries to know which benefits are included in their plans.
In addition, variability in coverage can affect the continuity of care for individuals already receiving treatment.
It’s for this reason that some efforts have been made to improve Medicaid’s dental coverage across US states. Some of the efforts made include:
- Using provider incentives to increase the number of dentists serving Medicaid beneficiaries. Some states are increasing reimbursement rates and simplifying admin procedures, thereby encouraging dentists to participate in their Medicaid programs.
- Using technology to increase dental coverage in some areas. For instance, in 2015, California began requiring its Medicaid program, Medi-Cal, to cover dental services provided by hygienists in consultation with actual dentists connected via the web, a practice known as teledentistry.
- Bringing dental benefits closer to underserved communities via coordination between community health centers and HRSA (Health Resources and Services Administration). HRSA offers capital expansion grants to support school-based and community health center efforts to improve their capacity to provide primary and preventive healthcare to underserved residents in these communities.
- Using loan repayment models to increase the number of dental practitioners who provide care to Medicaid recipients. The NHSC (National Health Service Corps) offers up to $50,000 in student loan reimbursement to health professionals, including dental practitioners, in exchange for a two-year obligation to work at an approved NHSC facility in a high-need underserved region.
All in all, if you or your child qualify for wisdom tooth extraction cover under Medicaid, you can schedule an appointment with a Medicaid-approved dental practitioner, and they will review your situation and expound on all available options.
For more info on Medicaid wisdom tooth extraction, head to https://www.medicaid.gov/medicaid/benefits/index.html.