Finding a nearby dentist that accepts Medicaid for adults can be an enormous challenge or as easy as pie – depending on where you live and the types of oral care needed.
First, Medicaid coverage for adult dental work varies widely by state. Many low-income patients have no benefits for specified services and may need to identify alternative ways to fund treatment.
Second, patients living in states that support the needed treatment have a simple solution. The online provider directory published by the Dental Benefits Manager associated with your specific plan is the final authority.
Your member ID card offers clues to this mysterious organization.
Dentists That Accept Medicaid by State
The first critical step in finding local dentists that accept Medicaid for adults is determining whether your state covers the specific oral care procedure you need.
Adult dental work covered by Medicaid varies state-to-state. Pick any specialized service, and the odds are about 50% that your plan might cover the treatment. If not, you may need to identify alternatives.
- Free clinics near your address might help – if available
- Financing with no credit check helps with immediate needs
Your neighborhood oral surgeon is most likely to take Medicaid for adults because the publically-funded program has a dual nature, resulting in better coverage for maxillofacial procedures.
First, Medicaid works as health insurance in all fifty states and covers medically necessary procedures performed by oral surgeons.
- Bony-impacted wisdom tooth extractions
- Jaw surgery to correct medical conditions
- Sleep Apnea
- Temporomandibular Joint Disorders (TMJ)
- Repair of cleft-palate and other congenital abnormalities
- Excision of cysts or tumors of the jaws or facial bones
- Reconstruction following surgical procedures for cancer
Second, Medicaid also works as dental insurance in twenty-four states that include oral surgery as a covered benefit.
|Minnesota||Nebraska||New Jersey||New Mexico|
|New York||North Carolina||Oregon||Pennsylvania|
|Rhode Island||South Carolina||South Dakota||Vermont|
Low-income adults will find it exceptionally difficult to identify a nearby orthodontist that takes Medicaid because dental braces rarely meet the two sets of coverage criteria.
The Medicaid health insurance component covers orthodontic braces in all 50 states only when medically necessary. However, these situations are uncommon.
- Reposition teeth after an accidental injury
- Correct bite alignment to address medical conditions
- Sleep Apnea
- Temporomandibular Joint Disorders (TMJ)
The Medicaid dental insurance component pays for orthodontic braces to correct malocclusion in patients older than 21 in only two states: Oregon and the District of Columbia (Washington DC).
The odds of an adult finding a local dentist that accepts Medicaid for dentures are slightly above fifty percent overall and depend on the policies in your residence state.
The Medicaid healthcare element (which applies nationwide) never pays for dentures because replacement teeth fall squarely into the oral care category and do not overlap with other covered services.
The Medicaid dental insurance component includes coverage for the least expensive dentures in 26 of the 50 states.
|Nevada||New Jersey||New York||North Carolina|
|Rhode Island||South Dakota||Utah||Virginia|
Adult patients can find a neighborhood periodontist that takes Medicaid about only 40% of the time because gum disease treatment typically falls into the oral care category.
The Medicaid healthcare component available throughout the country covers treatment from a periodontist only in rare cases. While gum disease correlates with heart problems and diabetes, only services before another covered cardiac surgical procedure might qualify for benefits.
The Medicaid dental care element includes periodontal treatment costs in only nineteen of the fifty states.
|Nebraska||New Jersey||New Mexico||New York|
|North Carolina||North Dakota||Pennsylvania||Rhode Island|
Your chances of finding a nearby endodontist 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 of tooth pulp diseases.
You might need to visit an endodontist to perform a root canal to repair a badly damaged tooth instead of removing it. In these cases, only 25 states support endodontic treatment.
|New Mexico||New York||North Carolina||North Dakota|
Adult patients typically find nearby walk-in dentists that take Medicaid 100% of the time because every state supports benefits for emergency dental work – although the types of procedures the program will cover will vary by the state once again.
The Medicaid healthcare element covers emergency dental work after covered injuries throughout the country. For instance, non-biting accidents that chip or dislodge teeth frequently qualify.
The Medicaid oral care component also pays for walk-in dental care in all fifty states. However, you might only receive treatment to stop bleeding, relieve pain, and prevent infection if you live in one of the nine states that only support emergency services.
Attempting to find a neighborhood dentist that takes both Medicaid and Medicare adds extra layers of complexity. Dual-eligible adults often face significant challenges locating rare points of intersection.
- Medicare Parts A, B, and D do not cover most forms of dental work. The only exceptions occur when an integral part of another covered services
- 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. If so, the private insurance company issuing the Advantage option publishes a list of participating providers.
Medicaid Dental Benefits Managers
The Dental Benefits Manager (DBM) connected to your account 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.
However, it could prove tricky to identify your DBM. Each state contracts with different private health insurance companies to administer the healthcare component, who then hire a DBM to manage oral care benefits.
For example, New Jersey Family Care members could end up referencing the online provider directory of two DBM companies.
|Insurance Company||Dental Benefits Manager|
|Horizon Blue Cross||BCBS|
Follow these steps.
- Take your member ID card out of your wallet
- Identify the private insurance company administering your plan
- Go to the organization website to ascertain the correct DBM
- Visit the DBM web portal and find the provider directory
- Input the specific plan name to get an accurate list of dentists
The majority of adults will wind up using the DentaQuest online provider directory to find a neighborhood dentist that accepts 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 exact network connected to your plan to get the most accurate listing.
Finally, finding a local dentist that takes straight Medicaid might prove tricky because a DBM might not be involved in the equation.
Straight Medicaid is a fee-for-service arrangement instead of a managed care plan (80% of recipients). In the fee-for-service programs, the state reimburses providers directly without an intermediary.
Therefore, straight Medicaid recipients should contact their state or county office to get a directory or listing of participating providers.