Last Updated on October 19, 2022 by Anne-Sophie Reinhardt
Patients looking to get dental implants can be confused by the topic of Medicaid cover. You might have lost a tooth due to an accident, and now you are wondering if Medicaid will pay for dental implants. It all depends on how each state resolves the issue. It is up to your State to decide what dental costs will be covered.
Medicaid is not a federal program, but a State-by-State program. Guidelines govern it. Even though Medicaid covers dental procedures in the US, many dentists refuse to accept it because of its large administrative overheads and low payment rates. Patients from low-income families are most affected by this because they have the greatest need for dental implants.
- 1 What Are Dental Implants?
- 2 Does Medicaid Cover Dental Implants for Patients Under 21 Years?
- 3 Does Medicaid Cover Dental Implants for Patients Over 21 Years?
- 4 Why Doesn’t Medicaid Routinely Pay for Dental Implants?
- 5 Can You Get Special Consideration for Medicaid to Cover Your Dental Implants?
- 6 Final Thought
What Are Dental Implants?
Implants are surgical procedures that place a dental structure into the jawbone to replace a missing tooth. Once the implant is in place, the abutment connects it to the actual tooth. Moreover, your jawbone condition is a significant factor in the process of placing a dental crown.
To determine if an implant is right for you, your dentist must first conduct a thorough assessment of your dental health. Even though dental implants are a great alternative to dentures or bridgework, they may not always work well.
So, patients who do not have natural teeth and cannot undergo total tooth replacements can consider dental implants.
Does Medicaid Cover Dental Implants for Patients Under 21 Years?
If you are under 21 years old and eligible for Medicaid, you will need to receive the EPSDT (Early Periodic Screening Diagnostics and Treatment) benefit.
Medicaid will cover the cost of any dental implant if you are eligible for EPSDT. This benefit has the main purpose of preventing and providing early diagnosis and treatment of medical conditions, such as dental problems.
Medicaid may cover the cost of dental implants if you are confirmed by your doctor that you require them to replace your permanent teeth. The EPSDT benefit benefits have some limitations and requires that a child’s medical coverage must include:
- Tooth repair.
- Treatment for pain relief and infections
- Dental wellbeing maintenance.
- Any procedure deemed medically necessary or recommended by a physician.
Medicaid won’t pay for dental implants if the conditions above are not met. They cover basic procedures like tooth extractions and denture replacements, partial or full.
Does Medicaid Cover Dental Implants for Patients Over 21 Years?
If you are over 21 years old, Medicaid may not pay for dental implant costs. It all depends on where you live in the US. However, Medicaid is different from one State to another regarding the types of dental procedures they may offer to patients older than 21 years.
There are many stages to the dental implant process. Medicaid may cover some of these parts but may not pay for the initial stages of the procedure. The organisation might pay for some steps of the dental implant procedure, such as:
- CT (Computed Tomography) scans. These scans are used to assess your bone structure and identify any structural anomalies.
- Tooth extraction due to injury, disease, or chronic condition.
- Bone grafting is performed due to an accident, disease, chronic condition, or injury.
- Implant frame surgically placed into your jaw bone.
It is important to remember that Medicaid does not cover all dental procedures. Not many US dentists accept Medicaid coverage. Studies show that only 38% accept Medicaid.
Why Doesn’t Medicaid Routinely Pay for Dental Implants?
Implants are an excellent treatment option. So why is Medicaid refusing to cover them? Medicaid considers dental implant procedures cosmetic, which is somewhat inaccurate since they prevent your teeth from moving and help you to stay healthy.
Dental implants are more expensive than other types of dental correction procedures. One dental implant can cost anywhere from 4000 to 6600 USD. This is why Medicaid does not cover dental implants.
It can be confusing considering that Medicaid helps low-income people afford their medical expenses.
Can You Get Special Consideration for Medicaid to Cover Your Dental Implants?
Medicaid may be able to grant you special consideration if you are certain that you require dental implants. You will need to show proof that the procedure is for medical reasons and not cosmetic.
Although it will be difficult and time-consuming, prior consent from Medicaid providers will be granted. You will need to submit supporting documents from a doctor or dentist.
You might also need the following documents:
- A description of how dental implants can help your medical state.
- Your dentist or physician should give you an explanation as to why denture fitting or bridgework isn’t the right option for your needs. This will force you to undergo the dental implant procedure.
- A complete mouth radiograph, or an analytical panorex. Dental procedures also use Panorex (exclusive 2D) X-ray. It shows the state of the upper and bottom teeth in one picture.
- The complete dental implant program.
The physician should inform you if you have any other conditions. Also, you should note any medications you are taking.
Let’s just say that there is no one right answer to the question of whether Medicaid will pay for your dental implants. There are many factors that can play into this.
It depends on where you live and what rules regarding dental care. As budgets change or drop for economic or political reasons, coverage can also change over time.
However, if you have a history with bad credit, you can find more information about Dental Financing for Bad Credits to support your payments.