Does Medicaid Cover Wisdom Teeth Removal?

Does Medicaid Cover Wisdom Teeth Removal? – Overview

In several states, Medicaid pays for wisdom teeth removal, but the extent of coverage and whether Medicaid pays for any other dental service varies from state to state.

While some state Medicaid plans only cover emergency dental procedures, all states can provide more comprehensive dental benefits to adults, but it is not federally required.

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, only kids can have their wisdom teeth removal procedures paid for by Medicaid.

Federal laws require State Medicaid programs to offer dental benefits to children 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:

1. Teeth restoration.
2. Relief of pain and infections.
3. 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 removing wisdom teeth for your child.

Adult Medicaid dental plans do not cover dental procedures for children; children’s dental coverage is provided through separate Medicaid dental benefits or CHIP.

However, you need to consult your local Medicaid office about any yearly confines on services and deductibles before this happens.

Which Dental Benefits are Included in Adult Medicaid Plans?

There is no federal law requiring state Medicaid programs to offer dental benefits to adults. As of recent data, Alabama and Tennessee do not provide dental services for adults under Medicaid; however, Delaware and Maryland offer limited dental benefits.

All other state Medicaid programs offer extensive, limited, or emergency dental benefits.

For instance, if a wisdom tooth is jammed and causing much discomfort, removal will be recognized as an emergency 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 includes:

1. California
2. Colorado
3. Connecticut
4. District of Columbia
5. Idaho
6. Illinois
7. Iowa
8. Massachusetts
9. Montana
10. New Jersey
11. New Mexico
12. New York
13. North Carolina
14. North Dakota
15. Ohio
16. Oregon
17. Rhode Island
18. Washington
19. Wisconsin

The list of State Medicaid programs that offer limited dental benefits include:

1. Arkansas
2. Hawaii
3. Indiana
4. Kansas
5. Kentucky
6. Louisiana
7. Michigan
8. Minnesota
9. Mississippi
10. Missouri
11. Nebraska
12. Pennsylvania
13. South Carolina
14. South Dakota
15. Vermont
16. Wyoming

Finally, the list of State Medicaid programs that offer emergency-only dental benefits include:

1. Alaska
2. Arizona
3. Florida
4. Georgia
5. Maine
6. Nevada
7. New Hampshire
8. Oklahoma
9. Texas
10. Utah
11. Virginia
12. West Virginia

How Much Does It Cost to Remove Wisdom Teeth?

If your child’s wisdom teeth are like any other teeth, they can be removed easily if necessary.

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.

The cost of extracting a typical wisdom tooth with local anesthesia usually ranges from $150 to $400 per tooth.

The cost to remove an impacted wisdom tooth typically ranges from $225 to $600 per tooth, which usually includes the cost of anesthesia.

As illustrated above, many states have limits in places where dental services can be paid for within a certain period.

Also, some 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

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.

For this reason, some efforts have been made to improve Medicaid’s dental coverage across US states. Some of the efforts made include:

1. Using provider incentives to increase the number of dentists serving Medicaid beneficiaries. Some states are increasing reimbursement rates and simplifying admin procedures, encouraging dentists to participate in their Medicaid programs.
2. Technology can be used 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.
3. 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.
4. 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.

Final Thought

All in all, if you or your child qualify for wisdom tooth extraction coverage 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.

See Also

Does Medicaid Cover Braces

Does Medicaid Cover Dental Implants?

Does Medicare Cover Hearing Aids

Does Medicare Cover Dental Implants

How to Get Dental Implants Covered by Insurance