Last Updated on October 27, 2022 by Anne-Sophie Reinhardt
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 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
Federal law requires that state Medicaid programs include a minimum set of dental benefits for children. For example, these include:
- Restorative dentistry.
- Pain relief and infection treatment
- Maintaining good dental hygiene.
Although wisdom teeth removals do not count as part of the minimum requirements, many state Medicaid programs offer higher benefits than the federal requirements. They could also pay for wisdom teeth removal for your child.
Adult Medicaid Dental Plans can partially cover your child’s wisdom teeth removal. Before you make this happen, it is important to check with your local Medicaid office regarding any yearly restrictions on services and your deductibles.
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, Tennessee).
All state Medicaid programs provide extensive, limited or emergency dental benefits. Besides, an emergency procedure is a jammed wisdom tooth that causes severe discomfort . So, a healthy wisdom tooth growing is typically not an emergency, and Medicaid may deny covering.
As per the CHCS, the list of State Medicaid programs that offer extensive dental care include:
- District of Columbia
- New Jersey
- North Carolina
- North Dakota
- New York
- New Mexico
- Rhode Island
The list of State Medicaid programs that offer limited dental benefits include:
- South Carolina
- South Dakota
Finally, the list of State Medicaid programs that offer emergency-only dental benefits include:
- New Hampshire
- West Virginia
How Much Does It Cost For Wisdom Teeth Removal?
Wisdom teeth can be easily removed if they are not like other teeth. Moreover, if the wisdom teeth come unusually or are positioned sideways, these are called crowded wisdom teeth. Therefore, they are more challenging to extract. They can also take longer, increasing procedure costs.
So, a typical wisdom tooth can be extracted using an anaesthetic (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.
Some efforts have been made across the US to increase Medicaid’s coverage for dental care. For example, among the many efforts are:
- Provider incentives can increase the number of dentists who serve Medicaid beneficiaries. Moreover, some states have simplified administrative procedures. They also increase reimbursement rates, encouraging dentists to join their Medicaid programs.
- 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.
- 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.
- 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 up to $50,000 to dental professionals. This exchanges for two years of service at an approved NHSC facility.
If you or your child are eligible for Medicaid wisdom tooth extraction, you can make an appointment with a Medicaid approved dentist to review your case and also discuss all options. So, visit the Medicaid website for more information about wisdom tooth extraction coverage.
Moreover, besides extraction coverage, Medicaid also provides further scope for dental implants. Let’s find out!