Are There Dentists that Take Medicaid?

Need a dentist that takes Medicaid near you? That can be a tall order. Only 39% of U.S. dentists participate in Medicaid or the Children’s Health Insurance Program (CHIP) for child dental services.

If you are looking to find a dentist that takes Medicaid, Kool Smiles has you covered. We proudly accept Medicaid, TRICARE and other forms of payment, and have over 120 locations across 15 states, often positioned in communities with the greatest need. We also have extended weekday and Saturday hours, all to make dental care convenient for you and your child.

It’s important to understand how Medicaid works in order to get the proper dental treatment for your kids. To learn more about Medicaid and what your options for dental care are, call Kool Smiles at 254-781-0553 to schedule a no-cost consultation.

How Does Medicaid Work?

Medicaid is the coverage 66.9 million people rely on. It is a joint federal and state program that covers low-income families (a federal requirement) and sometimes other groups that states choose to cover, like children in foster care.

Because the program is offered nationwide but varies in its coverage state by state, Medicaid can be tricky to navigate. It can also be a little complicated to figure out what qualifies for “low income.” Many people find they make too much money to qualify for Medicaid but too little to afford other insurance. Programs like CHIP help bridge the gap by providing low-cost coverage for children of families who aren’t eligible for Medicaid but still need assistance. This coverage extends from health to dental coverage when the care is deemed “medically necessary.”

Have a question about your dental plan, finding a dentist that takes Medicaid or what health services are covered by Medicaid or CHIP? Read these FAQs to learn more about Medicaid.

FAQs: Using Medicaid at the Dentist

What will Medicaid pay for?

Medicaid includes dental healthcare for children under the age of 18. This goes beyond the oral screening children may receive at their annual physicals and covers maintenance of dental health, relief of pain and infections, and restoration of teeth. However, the services Medicaid will cover vary from state to state. Since Medicaid is a federal program that partners with states, each state decides how and what is covered, as well as how often a service can be provided.

Typically, though, Medicaid patients are covered for dental procedures that are deemed medically necessary for their oral health. These include dental checkups and screenings, cleanings and other preventative care, plus restorative treatments like fillings that keep mouths happy and healthy.

Dental services that are not medically necessary will likely mean some out-of-pocket costs, but Kool Smiles can work with you to form a payment plan that fits your budget. Treatments that might not be deemed medically necessary include certain types of crowns, dentures or braces without prior authorization.

Note: while it varies a bit by state, “medical necessity” is defined as “reasonable and necessary for the treatment of illness, injury, disease, disability, or developmental condition.”

As a general rule, dentists who accept Medicaid are required to provide Early and Periodic Screening, Diagnosis and Treatment services (EPSDT). That translates to services intended to keep kids’ teeth healthy before costly and painful problems crop up.

What does EPSDT mean when it comes to my kids’ teeth?

Your Medicaid benefits will help you keep your children’s teeth healthy and treat any problems while they’re small. The “Early” and “Periodic” parts of EPSDT refer to the practice of having dental health assessed, or “Screened,” regularly and before symptoms are noticed, so that “Diagnosis” and “Treatment” can occur while any issues are minor and relatively inexpensive. Medicaid covers these services because dental care is key to children’s overall health.

Dental problems can cause:

Researchers have also found ties between oral infections and other problems, from heart issues to diabetes, making dental screenings an important indicator for overall health.

Note: The “Periodicity” schedule (the “P” in EPSDT that refers to how often care is covered) may vary according to state. Check in with your state to find out how often you’re eligible for covered visits to the dental office and which services exactly are covered. Kool Smiles can help you navigate this information. Just give us a call at 254-781-0553 to talk through your coverage, set up a no-cost consultation and see a qualified dentist that takes Medicaid.

What treatments are covered by Medicaid?

With Medicaid benefits, and depending on your state’s coverage, your kids are able to receive:

  • Screening procedures to support dental health including include dental examinations, oral health screenings, tooth decay risk assessments and X-rays
  • General dental health services to relieve pain, remove tooth infection and restore dental health
  • Preventative care, such as cleanings, sealants, and possibly fluoride treatments and space maintainers
  • Therapeutic services, such as fillings and crowns, root canals and possibly antimicrobial treatments to stop decay from spreading
  • Services that fall into the “medically necessary” category when receiving any of the above treatments, like anesthesia during a filling

Did you know sealants on molar teeth can reduce the risk of cavities by 80%, according to the American Dental Association? Prevention works!

Is there a limit on what Medicaid covers for my kids?

There are limits to the types and number of procedures covered by Medicaid. For example, your child might only be allowed one cleaning per year or sealants during two separate office visits. You’ll want to check with your state-specific guidelines to be sure, but Kool Smiles can help you determine which services may or may not be covered by Medicaid, as well as how often they will be covered.

There are also treatments that might fall outside the category of medically necessary in certain situations.

Kool Smiles dentists take Medicaid at all of our offices, and we’ll work with you on finding a payment plan that fits your budget for services not covered. If you’re a member of the military or a reservist, we also take TRICARE.

How can I get somebody to explain my Medicaid benefits to me?

It can be hard to communicate with government services. At Kool Smiles, we deal with state Medicaid programs every day and understand how they work. When you make your appointment, we’ll be happy to explain your coverage options and what services are covered under your plan. During a no-cost consultation, we can walk you through all your options and discuss how much Medicaid might cover for your specific situation.

How long should I wait to schedule a dentist appointment?

Don’t wait! Preventative care can save you time and money, as well as save your child discomfort and missed school days. Research has shown that the average amount of money spent on dental services a year for the U.S. population actually skews high because of expensive non-annual procedures. Half of all dental patient costs were $254 or less in 2013, but the average cost was $685—much higher because of expensive therapeutic procedures that place a financial burden on patients. Overall, preventative care is much less expensive than therapeutic care. Studies have estimated that each dollar spent on prevention saves $8–$50 in procedures.

Even small fillings are much less expensive than root canals, so prevention and early detection will keep your costs down in the long run.

See a Dentist That Takes Medicaid Today

With over 120 locations of Kool Smiles dental offices that take Medicaid, it’s easy to find one near you. Give us a call today at 254-781-0553 to schedule an appointment.

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Sources:

ADA: ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIGraphic_0318_1.pdf?la=en

TRICARE: tricare.mil/Dental.aspx

Medicaid.gov: medicaid.gov/medicaid/index.html

Medicaid.gov: medicaid.gov/medicaid-chip-program-information/by-topics/waivers/1115/downloads/list-of-eligibility-groups.pdf

Medicaid.gov: medicaid.gov/medicaid/eligibility/index.html

Medicaid.gov: medicaid.gov/state-overviews/index.html

National Academy for State Healthcare Policy: nashp.org/medical-necessity/

American Speech-Language-Hearing Association: asha.org/Practice/reimbursement/medicaid/Medicaid-Toolkit-Medical-Necessity/

Medicaid.gov: medicaid.gov/medicaid/benefits/epsdt/index.html

National Institute of Dental and Craniofacial Research: nidcr.nih.gov/research/data-statistics/surgeon-general#major-findings

The National Center for Biotechnology Information: ncbi.nlm.nih.gov/pmc/articles/PMC3482021/

The National Center for Biotechnology Information:

ncbi.nlm.nih.gov/pmc/articles/PMC3894098/

UCSF: ucsf.edu/news/2017/09/408206/top-avoidable-emergency-room-visits-alcohol-dental-issues-and-depression

InsureKidsNow.gov: insurekidsnow.gov/coverage/index.html

American Dental Association: ada.org/en/member-center/oral-health-topics/dental-sealants

American Dental Association: ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0316_4.pdf

University of Illinois: dentistry.uic.edu/blog/value-preventive-oral-health-care