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 set of 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 offer benefits that exceed the 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 2024, Alabama is the only state that does not provide dental services for adults under Medicaid; Tennessee now offers extensive dental benefits for adults and both Delaware and Maryland provide limited adult dental benefits. (1)

Except for Alabama, all other state Medicaid programs (and Washington, D.C.) now offer at least some adult dental benefits, whether extensive, limited, or emergency-only coverage.

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 of 2024, the list of state Medicaid programs that offer extensive adult dental benefits includes:

Alaska
California
Colorado
Connecticut
District of Columbia
Hawaii
Idaho
Illinois
Iowa
Kansas
Kentucky
Maine
Massachusetts
Michigan
Minnesota
Montana
Nebraska
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Tennessee
Utah
Virginia
Washington
Wisconsin

The list of state Medicaid programs that offer limited adult dental benefits includes:

Arkansas
Delaware
Indiana
Louisiana
Maryland
Missouri
Pennsylvania
South Carolina
South Dakota
Vermont
West Virginia
Wyoming

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

Arizona
Florida
Georgia
Mississippi
Nevada
Texas

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.

Without insurance, the cost of extracting a typical erupted wisdom tooth with local anesthesia usually ranges from about $200 to $700 per tooth. (2)

Without insurance, the cost to remove an impacted wisdom tooth typically ranges from roughly $250 up to $1,100 per tooth (including anesthesia).

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

Also, some states impose annual dollar spending caps on adult dental benefits, typically ranging from around $500 up to $1,500 per year.

With dental insurance, however, patients usually pay far less for wisdom tooth removal, as many insurance plans cover around 50% to 80% of the extraction cost

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 qualifies 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