Adults and seniors often wonder whether Medicaid covers dental implants in their state because the procedure is expensive.
The simple answer is no in 2022, but government programs are notoriously challenging to navigate, and the critical line between medical and dental care is fussy.
First, learn how Medicaid covers dental implants differently by exploring its dual nature as health (starts in the body) and dental insurance (begins in the mouth).
Second, instead of asking which states pay for dental implants through Medicaid, identify the ultimate authority and direct your questions to them. A Managed Care Organization or Dental Benefits Manager could be the final judge.
When Does Medicaid Pay for Dental Implants
In most cases, Medicaid does not cover dental implants for adults. However, this taxpayer-funded program has a dual nature, opening the door for two possible exceptions.
While your mouth is part of your body and affects overall health, the insurance world treats them as separate entities.
- The health insurance component often pays for medically necessary treatment uniformly across the country when the problem originates elsewhere in your body
- The dental insurance element pays for the least expensive alternative in states supporting specific oral care benefits when the problems start in your teeth or gums
Free dental implants for low-income patients via clinical trials, makeovers, non-profits, and grant programs are often more feasible unless you can sneak through two possible loopholes.
As the first loophole, Medicaid is likely to pay for all dental implant treatment steps when it acts as health insurance (the problem started elsewhere in your body or resulted from a non-biting accident). The rules apply uniformly across the country for medically necessary oral care: treatment of illness, injury, disease, disability, or developmental condition.
You get the health insurance component to cover dental implants by documenting the medical necessity. You will need letters from your physician and dentist detailing the underlying illness or injury that requires permanent implants rather than removable dentures.
For instance, the health insurance component of Medicaid might cover tooth implants in at least two cases.
- Prevent further bone atrophy caused by diseases such as diabetes, digestive disorders, or osteoporosis
- Strengthen the jaw bone after accidental fractures or surgery to remove cancerous lesions
Medicare might cover dental implants for dual-eligible seniors experiencing similar health problems originating outside of the mouth. However, only Advantage plans include benefits for oral care connected with decay or periodontal disease.
In the second loophole, Medicaid might pay for some tooth implant treatment steps when acting as dental insurance (the problem started in your mouth from decay or periodontal disease). However, three critical rules vary across the country.
Medicaid covers dentures in thirty-three states under the dental insurance element, meaning many adults with missing teeth have a viable alternative to restore their smile and ability to chew and enjoy food.
The least costly treatment rule means that your state is more likely to support dentures than dental implants to restore function.
Medicaid covers oral surgery in twenty-six states under the dental insurance component. Your plan could pay for these early-stage tooth implant treatments depending on the benefits in your region.
- Tooth extractions
- Cone Beam Computed Tomography (CT)
- Bone grafting
- Sinus lift
Medicaid covers crowns and bridges in the twenty-six states with restorative benefits under the dental insurance component.
Restorative dentistry replaces missing or damaged teeth. Your plan may pay for the crown or bridge that fits onto the abutment, but not several interim steps.
- Surgical implant body placement: no
- Surgical implant abutment installation: no
- Crown or bridge: maybe
States that Cover Dental Implants Through Medicaid
The correct answer to which states cover dental implants through Medicaid depends on why your treatment falls under the health insurance versus dental insurance component (see above).
- All states pay for tooth dental implants when the adult patient has a well-documented medically necessary reason (health insurance)
- Medicaid covers dental work for adults differently in every state for patients who lost teeth due to caries or gum disease (dental insurance)
- Dental implants take Medicaid when your plan pays for the proposed treatment, and the office accepts reimbursement as full payment
The private third-party company administering claims for your plan is the ultimate authority, and you have two possible places to turn for your final answer.
Managed Care Organizations
All states cover dental implants through Medicaid when adult patients have a medically necessary reason. A Managed Care Organization (MCO) adjudicates claims and is the ultimate authority in these cases.
An MCO is a private third-party company that administers claims processing for the health insurance component. Submit the letter of medical necessity composed by your physician and dentist to the MCO printed in bold letters on your member ID card.
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
Dental Benefit Managers
Some states might cover early and late-stage dental implant procedures when adult patients lose teeth due to decay or periodontal disease. In these cases, a Dental Benefits Manager (DBM) adjudicates claims and is the ultimate authority.
A DBM is a private third-party company that administers claims for the dental insurance element. Find the DBM name from your member ID card and have the provider submit correspondence and claims information to the organization chosen by your state.
- Liberty Dental
- Managed Care of North America (MCNA)
- Delta Dental
Finally, many adults begin asking whether their Medicaid plan pays for dental implants by substituting a branded nickname concocted by their state. Do not feel bad if you fall into this trap. You have plenty of company.
Just scroll back to the top if you found this article by searching for any of these brand names that confuse many people – especially seniors.
|State||Brand 1||Brand 2|
|Colorado||Health First Colorado|
|Georgia||Peach State Health Plans|
|Illinois||Medical Card||County Care|
|Indiana||Hoosier Care||HIP Plus|
|Kentucky||Passport||KY Health Choices|
|Michigan||Medical Assistance||Healthy Michigan Plan|
|New Jersey||NJ Family Care|
|New York||Healthy Choice|
|North Carolina||Health Choice|
|Oregon||Oregon Health Plan|
|South Carolina||Healthy Connections|
|Virginia||Cover Virginia||Family Access to Medical Insurance Security|