Finding a nearby dentist that accepts Medicaid for adults can be an enormous challenge or as easy as pie – depending on where you live, the types of oral care needed, and other factors.
First, the health insurance element covers dental work across the country when medically necessary: connected to accidental injury or disease.
Second, the medical assistance is sometimes dental insurance, but the benefits vary widely in each state for oral care.
Third, you need to find providers in your area that take your specific plan rather than what others might have. Finally, state offices outsource administration to outside companies, adding a layer of confusing names and acronyms.
Dental Places that Accept Medicaid
Adults often face a stark reality when looking for nearby dental places that accept Medicaid patients for specific procedures. The odds of success are about 50%, and you might need to find an alternative.
Dental assistance programs might prove more fruitful when three possible shortcomings apply to your situation.
- Oral care coverage varies extensively from state-to-state
- Dental specialties have the widest state disparities
- The least costly alternative rule limits treatment options
- Dental Places that Accept Medicaid
- Dental Specialists Taking Medicaid
- Dentists Taking State Insurance (Medicaid)
Dental clinics for low-income families frequently take on adult Medicaid patients knowing that they cannot afford proper oral care otherwise. These sliding-scale places often operate in the states with the weakest oral care benefits in their medical assistance programs.
Dental charities offer pro bono services at clinics sprinkled countrywide. Search for local non-profit organizations that treat adults. However, expect to pay a portion of the fees for more advanced treatment: gum surgery, dentures, etc.
Dental schools run clinics and frequently take adult Medicaid recipients. Future dentists supervised by faculty often treat low-income patients at sharply reduced fees so the students can hone their craft before entering private practice.
If you need dental work but have no money, you could get lucky and find affordable care at a school in your area – especially if you live in a large urban area. However, these clinics are not free.
Neighborhood family dental offices throughout the nation are most likely to accept Medicaid patients because they provide the general treatments typically covered by your state insurance.
Most states (41 out of 50) pay for preventive oral care that family dentists provide routinely: regular oral exams, cleanings, and X-rays. The old saying, “An ounce of prevention is worth a pound of cure,” holds especially true for low-income families because they often lack the resources to pay for expensive treatment.
Looking for pediatric dental offices that take Medicaid in your area is the most direct way to find a provider that takes adult patients. Medical assistance provides comprehensive and preventive oral care services for children under age 21 across the nation.
The Centers for Medicare & Medicaid Services maintains an online directory of participating places for children. Many of these offices also treat adults – provided your state insurance supports the specialized service for patients older than 21.
- Select your state
- Choose the plan
- Enter your zip code
- Check off accepts new patients
Finding a local dentist that takes Medicare and Medicaid will prove incredibly challenging. Adding an extra point of intersection narrows the list of places significantly.
Dual eligible patients have both Medicare and Medicaid, but they are not doubling their dental benefits in most cases.
- Medicare Parts A, B, and D do not cover most forms of dental work except when an integral part of another covered service
- Tooth extractions before radiation therapy
- Treatment after accidental injury to the jaw
- Dentists often accept Medicare Part C (Advantage Plans) when oral care is part of the state-approved policies. However, dual-eligible recipients rarely have this plan type.
For example, only oral surgeons might take Medicare and Medicaid because they sometimes perform operations covered under the healthcare components of both plans.
Dental Specialists Taking Medicaid
Specialists have additional training beyond dental school, making them more proficient when diagnosing and treating specific oral health problems. Your ability to find a specialist near you that accepts Medicaid for adults hinges on the dual nature of the public program.
- Medicaid acts as health insurance countrywide and pays for medically necessary oral care: arising from non-biting accidents, certain diseases, and treatments considered integral to other services included in the plan
- Medical assistance operates as dental insurance for adults with different oral care benefits available to adults over 21 in each state
The chances of finding a local emergency dentist that takes Medicaid for adults are highest because all fifty states cover urgent care under the dental and healthcare components. However, benefits might be limited depending on where you live.
Medicaid covers medically necessary dental emergencies throughout the country: walk-in treatment for non-biting accidents that break, dislodge, or chip teeth and jaw structures. For instance, you should easily find an emergency oral surgeon if you broke your mandible during a fall or auto wreck.
The dental component also covers emergency care nationwide, but nine states limit claim payments to specific procedures (stop bleeding, relieve pain, and prevent infection). For instance, emergency tooth extraction could be covered benefit under these parameters, but little else.
Finding an oral surgeon in your area that accepts Medicaid patients is typically most accessible because your plan is most likely to approve the claims they submit after treatment.
An oral and maxillofacial surgeon specializes in treating diseases, injuries, and defects in the head, neck, face, jaws, and mouth. Your state insurance could pay for treatment for one of three reasons.
- Oral surgeons sometimes perform medically necessary procedures, which Medicaid often covers across the nation as part of its primary mission: affordable healthcare for low-income families
- Oral surgeons sometimes perform dental procedures that are not medically necessary, which medical assistance covers in twenty-four states as part of its secondary mission
- Teenagers have comprehensive dental benefits but become adults at age 18 or 21, depending on state rules
Locating a local prosthodontist that accepts Medicaid for adults could prove relatively easy or extremely difficult depending on the type of treatment you want. Prosthodontists specialize in the restoration of missing tooth and jaw structures.
Patients with a gap in their smile will find that denture coverage surpasses implants across the nation because of the least costly alternative rule.
Adults countrywide are unlikely to find a prosthodontist that takes Medicaid for dental implants because this permanent tooth replacement option is never the least costly alternative.
Free tooth implant programs for low-income patients might be a better way to go. However, be prepared to wait in a long line or switch to dentures to address your missing teeth more quickly.
Prosthodontists that take Medicaid for dentures are more abundant. Still, you have to have realistic expectations about the quality of false teeth you might get because of the least expensive treatment rule.
- Medicaid pays for dentures in thirty-three highly populated states, meaning the average patient has a 75% chance of having coverage.
- Denture costs can range from $500 to $8,000 depending on the quality of materials used, arches fabricated and fitted, and the number of artificial teeth you need.
For example, same-day dentures are not the least expensive treatment alternative. Even if you live in one of the twenty-six states that support benefits, your plan may not honor claims for immediate replacement teeth.
Orthodontists accepting Medicaid for braces are more common. Still, the best strategy for finding a local provider depends on the recipient’s age and the reason they need to straighten their teeth.
Medicaid covers braces for adults and children differently following its dual nature.
- The health insurance component covers orthodontic braces in all 50 states for adults and children when medically necessary (rare)
- The dental insurance component pays for orthodontic braces to correct a handicapping malocclusion across the country up to age 21
In other words, most orthodontists that take medical assistance are treating young adults still classified as children by their state.
Adult patients can find a neighborhood periodontist that takes Medicaid about only 40% of the time because your state insurance is less likely to cover their procedures.
A periodontist is a dentist who specializes in preventing, diagnosing, and treating gum disease. Most of these procedures fall into the dental rather than medical category.
- While gum disease correlates with heart problems and diabetes, only services before another covered cardiac surgical procedure might qualify as medically necessary
- The dental care element covers periodontal treatment costs in only nineteen of the fifty states
Your chances of finding an endodontist in your area that takes Medicaid for adults are about 50% and depend entirely on the state where you live because the healthcare component rarely pays for the treatment.
An endodontist specializes in diagnosing and treating tooth pain and performing root canal treatment. A root canal eliminates dangerous bacteria by removing tooth pulp, cleaning and disinfecting the remaining dentin, and sealing the tooth.
Root canals are rarely medically necessary, so the healthcare component does not apply. However, twenty-five states support endodontic procedures.
Dentists Taking State Insurance (Medicaid)
It often proves tricky to find a dentist accepting Medicaid for adults near you because of a confusing array of names, acronyms, and multiple fingers in the pie.
Patients have to wade through an alphabet soup of brand names, managed care organizations (MCO), plan variations, and dental benefit managers (DBM).
Medicaid Brand Names
Many states assign brand names to their programs, which complicates finding local dentists that take Medicaid. Recipients are familiar with these monikers, so they often begin their online search using these terms.
Do not feel ashamed if you found this how-to-article after searching online using one of these branded nicknames cooked up by your state. You have plenty of company.
Your task is to identify the MCO and DBM associated with your plan. Skip to the relevant sections.
|State||Brand 1||Brand 2|
|Illinois||Medical Card||Illini Care|
|Kentucky||Passport||KY Health Choices|
|New Jersey||NJ Family Care|
|New York||Healthy Choice|
|North Carolina||Health Choice|
For example, you might have to follow several paths to find Illinois dentists that take Medical Card for adults. Recipients enrolled in managed care plans should follow instructions on the back of their membership ID, while those enrolled in the straight program (fee-for-service) need to visit Dentaquest.
Managed Care Organizations
Another complicating factor for adults looking for local dentists taking Medicaid is that each state subcontracts administration to private companies called managed care organizations (MCO).
Take the member ID card out of your wallet and look for the name of the MCO printed there. Go to that organization’s website to identify the dental benefits manager (DBM; see below) associated with your plan.
As you can see, each state can choose multiple MCOs to administer their plans, so it is understandable if you are confused.
- Aetna Better Health: CA, FL, IL, KS, KY, LA, MD, MI, NJ, NY, OH, PA, TX, WV, VA
- Amerigroup: NJ
- Anthem: CA, IN, KY, NV, VA, WI
- Blue Cross Blue Shield: is a national federation of affiliated companies using this trade name, operating in twenty-four states
- Caresource: GA, IN, OH
- Emblemhealth: NY
- Fidelis: NY
- Healthfirst: NY
- Humana: FL, IL, KY
- Meridian: IL, IA, MI
- Metroplus: Five boroughs of NCY – Bronx, Brooklyn, Manhattan, Queens, and Staten Island
- Molina: CA, FL, ID, IL, KY, MI, MS, NM, NY, OH, SC, TX, UT, WA, WI
- MVP: NY, VT
- United Healthcare: Offers plans nationwide
- UPMC Health Plan: MD, OH, PA, WV
- Sunshine Health: FL
- Staywell: FL
- Wellcare: AZ, FL, GA, HI, KY, MO, NE, NJ, NY, SC
Looking for a nearby dentist that accepts adult Medicaid patients is not precise enough. You should find a provider that takes your specific plan, and each state supports several variations.
Not all plans work the same way, so you have to identify the exact coverage and the benefits it conveys. You should find this information on your ID card.
The only dentist likely to take emergency Medicaid patients in your area would be the places that provide urgent care: stop bleeding, relieve pain, and prevent infection.
The emergency plan covers acute care for severe medical conditions. It serves people who meet the full scope income criteria but are ineligible because of their immigration status.
Limited Pregnancy Medicaid
Dentists are less likely to take limited pregnancy Medicaid patients because the oral care benefits for pregnant women are restricted – hence the name. Recipients with this plan earn too much money to qualify for the full scope version.
However, women older than 21 enrolled in the limited-pregnancy pathway could enjoy dental care otherwise denied to adults if they reside in Louisiana, Missouri, Nevada, or Oklahoma.
Finding a dentist in your area that takes full-scope Medicaid should prove the easiest because it covers the most services: hence the name. New patients with full-scope plans can enjoy all the oral care benefits mandated by their state.
Most full-scope recipients have managed care plans that require you to identify the MCO and DBM.
Finding straight Medicaid dentists in your area requires a different approach because you will have to contact the state instead of an intermediary. Straight plans are fee-for-service arrangements rather than managed care contracts.
- Contact your state agency rather than an MCO to find oral surgeons that accept straight Medicaid for procedures that fall into the healthcare category
- Reach out to your state agency rather than a DMO to find general dentists that take straight Medicaid when the treatment fits into the oral care category
Dental Benefit Managers
Finally, the Dental Benefits Manager (DBM) chosen by the MCO provides a direct, reliable route to find a local dentist that accepts Medicaid for adults for your specific plan. Of course, this assumes that your state supports oral care benefits for the needed treatments.
Most adults will wind up using the DentaQuest online provider directory to find a neighborhood dentist that takes their specific Medicaid plan. DentaQuest is the nation’s largest DBM, supporting 30 state programs and serving over 25 million recipients.
Begin at the DentaQuest member webpage and follow these steps.
- Click on the link for your state
- Follow the “Find a Dentist” link
- Enter the zip code for your address
- Choose the exact Medicaid plan for your state
- Search by dentist name, specialty, facility, or type
Another large group of adults could end up using the Liberty provider directory to locate a dentist situated near them that takes their Medicaid plan. Liberty operates as a DBM supporting 2.7 million recipients in 10 states.
|Missouri||Nevada||New Jersey||New York|
Start at the Liberty web-based find a dentist tool associated with your residence state. Search by zip code, distance, and specialty, or use advanced parameters such as license or NPI number.
A minority of adults will wind up using the Managed Care of North America (MCNA) provider directory to find a neighborhood dentist that takes their Medicaid plan. As a DMB company, MCNA supports programs in 8 states, but the two with the largest populations provide limited oral care benefits for people over 21.
- Comprehensive: Arkansas, Idaho, Iowa, Louisiana, Nebraska, Utah
- Emergency, Preventive, and Dentures: Florida
- Emergency Only: Texas
Begin at the NCNA online find a dentist tool. Input your city and state into the search widget and select the plan indicated on your member ID card to assure accurate results.
Patients living in New York State might use the Delta Dental DBM provider directory to find a local dentist that takes their specific Medicaid plan. Delta Dental manages oral care benefits for several adult programs.
- Capital District Physicians’ Health Plan (CDPHP Select)
- Health and Recovery Plans (HARP)
- Essential Plan
Utilize the Delta Dental Find a Dentist online search tool to develop your list. Make sure to verify the network connected to your plan to get the most accurate listing.