Does Medicaid Cover Wisdom Teeth Removal or Extraction?

Last Updated on January 16, 2024 by Lori Pace

Medicaid does cover wisdom teeth removal in many states. However, the state’s coverage and eligibility for other dental services vary. Some State Medicaid plans pay only for emergency dental procedures. Moreover, states do not have to offer dental benefits to Medicaid recipients. So, dental benefits are an option.

Does Medicaid Cover Wisdom Teeth Removal
Medicaid covers wisdom tooth removal in many states.

Does Medicaid Cover Wisdom Teeth Removal?

Medicaid is available in certain states that may cover wisdom tooth removals for children and adults. However, for wisdom teeth removals for children, Medicaid can only pay in some other states. Children under the Medicaid program or CHIP (Children’s Health Insurance Program) receive dental benefits because federal laws require it.

Medicaid Dental Benefits Included In Children’s Medical Plans

As someone who’s delved into the intricacies of Medicaid dental coverage, I’ve discovered a vital aspect to consider: children’s dental benefits within Medicaid. Federal law mandates that state Medicaid programs provide a foundational range of dental services for kids, like restorative dentistry, pain relief, and maintaining oral hygiene. While wisdom teeth removal isn’t listed in these mandatory offerings, the good news is that numerous state Medicaid programs go above and beyond by extending additional benefits beyond federal standards. This often translates to the potential coverage for wisdom teeth removal for your child.

In my exploration of Medicaid nuances, I’ve unearthed an interesting facet: adult Medicaid dental plans that can offer partial coverage for your child’s wisdom teeth removal. However, before taking any steps, it’s crucial to connect with your local Medicaid office. They can provide insights into potential yearly service limits and deductibles that might affect the coverage your child can receive.

Medicaid Dental Benefits Included In Adult Medicaid Plans

Medicaid Dental Benefits Included In Adult Medicaid Plans

No federal law requires that states offer dental benefits to adult residents through Medicaid programs. So, according to the Center for Health Care Strategies (CHCS), there are four states that do not pay for dental services (Alabama, Delaware, Maryland, and Tennessee).

In my journey through the realm of Medicaid, I’ve come to understand that each state’s Medicaid program offers a spectrum of dental benefits, ranging from comprehensive to emergency-only coverage. An essential point to remember is that Medicaid generally reserves emergency procedures for cases involving severely painful jammed wisdom teeth. Understandably, the growth of a healthy wisdom tooth is usually not deemed an emergency, and this might result in Medicaid not covering such a scenario.

As per the CHCS, the list of State Medicaid programs that offer extensive dental care includes:

  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Idaho
  • Illinois
  • Iowa
  • Massachusetts
  • Montana
  • New Jersey
  • North Carolina
  • North Dakota
  • New York
  • Ohio
  • New Mexico
  • Oregon
  • Rhode Island
  • Washington
  • Wisconsin

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

  • Arkansas
  • Hawaii
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Nebraska
  • Pennsylvania
  • South Carolina
  • South Dakota
  • Vermont
  • Wyoming

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

  • Alaska
  • Arizona
  • Florida
  • Georgia
  • Maine
  • Nevada
  • New Hampshire
  • Oklahoma
  • Texas
  • Utah
  • Virginia
  • West Virginia

How Much Does It Cost For Wisdom Teeth Removal?

Drawing from my own experiences, let’s delve into the cost aspect of wisdom teeth removal. Generally, if wisdom teeth align conventionally, removal is relatively straightforward. However, the dynamics change when wisdom teeth exhibit irregular growth patterns often referred to as ‘crowded wisdom teeth.’ These situations pose increased extraction challenges due to their sideways positioning. As a consequence, such extractions tend to be more intricate and time-consuming, potentially leading to higher procedure costs.

So, a typical wisdom tooth can be extracted using an anesthetic (numbing medication). It usually costs between 75 and 200 USD. However, the cost to extra remove a crowded wisdom tooth rises to between 250 and 600 USD. Moreover, this pluses the price fee for the numbing agent.

Many states have limitations on the number of dental services that they can pay within a given period. These states also have dollar limits set at between 500 and 2,500 USD each year.

What Efforts Have Been Made To Improve Medicaid Cover Wisdom Teeth Removal?

Dental coverage is just like any other type of health coverage. While federal law does not require states to offer dental coverage for adults, the majority of low-income people receive Medicaid dental benefits.

Medicaid dental benefits can vary from one state to another and from year to year, making it difficult to determine which benefits are covered by beneficiaries. Variability in coverage can also affect the continuity of care for people already receiving treatment.

Having personally delved into Medicaid’s evolving landscape, it’s heartening to see concerted efforts nationwide aimed at bolstering dental care coverage. Take, for instance, impactful measures like enticing provider incentives. These incentives can pave the way for more dentists to offer their services to Medicaid beneficiaries. On another front, some states have taken strides to simplify administrative procedures while simultaneously enhancing reimbursement rates. Such steps are geared towards fostering greater dental participation within the Medicaid framework.

  1. Technology can expand dental coverage in certain areas. For example, California required its Medicaid program, “Medi-Cal” to cover the services of hygienists. So, they were connected via the internet with actual dentists in 2015. This practice is known as Tele-Dentistry.
  2. Through coordination between community-based health centers and HRSA, dental benefits can be brought closer to those in need. HRSA also provides capital expansion grants to school-based and community-based health centers. In short, this aims to help them provide primary and preventive care to those who are most in need.
  3. To increase the number and quality of dentists who can provide care for Medicaid recipients using loan repayment models. So, the NHSC (National Health Service Corps), offers student loan reimbursement of up to $50,000 to dental professionals. This exchanges for two years of service at an approved NHSC facility.

Final Thoughts

Having navigated the complexities of Medicaid coverage myself, I can offer some practical advice for those considering wisdom tooth extraction under Medicaid. If you’re eligible, it’s wise to schedule a consultation with a dentist who’s approved by Medicaid. This step allows you to thoroughly discuss your case and explore the various avenues available. For more insights on wisdom tooth extraction coverage, a visit to the Medicaid website can be incredibly informative.

Moreover, besides extraction coverage, Medicaid also provides further scope for dental implants. Let’s find out!

Lori Pace
Lori Pace

Lori Pace is a single mother of three daughters ages 7 and under. As a working mom from home, she balances kids, work and two crazy dogs with humor and love. Follow Lori as she honestly gives tips and advice based on her own experiences as a single mom!