A seemingly simple question, “does Medicaid cover dentures for adults in 2022” can have a complicated answer.
First, the type of denture influences the answer because Medicaid acts primarily as health insurance and secondarily as dental insurance.
Second, thirty-three states pay for restorative care (false teeth) with several limitations, while seventeen others offer nothing.
Third, you will not find a reliable answer on the internet, and this article can only provide general guidance. The ultimate authority will be the private company administering claims for the type of dentures you need.
Finally, the Managed Care Organization or Dental Benefits Manager associated with your plan determines which claims to pay or reject.
When Does Medicaid Cover Dentures for Adults
The answer to whether Medicaid covers dentures for adults in 2022 has many layers and no single correct answer. The tax-payer-funded program has a dual nature affecting the kinds of false teeth covered.
- The health insurance component often pays for medically necessary services 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
Dental grants for low-income adults could prove a superior avenue for people living in states without the needed restorative care benefits and those wanting an upgrade over the least expensive treatment.
The health insurance component of Medicaid could pay for implant-supported dentures when medically necessary, regardless of the state where you live. The rules apply uniformly nationwide when treating an illness, injury, disease, disability, or developmental condition.
Medicaid covers dental implants across the country when needed to prevent further bone atrophy caused by diseases (diabetes, digestive disorders, or osteoporosis) or when required to reconstruct a broken jaw.
Two kinds of false teeth fit into this category because they transfer the pressure from biting and chewing directly to the jawbone, stimulating regrowth.
- Permanent dentures remain in your mouth but cost more
- Snap-on dentures require removal at night for cleaning
Free permanent dentures for seniors on Medicare follow the same protocol. Osteoporosis occurs frequently with the elderly and could form a solid basis to establish medical necessity.
The dental insurance element of Medicaid could pay for tooth-supported dentures that rest on the gums to restore smiles and chewing function. However, two caveats determine the benefits you might receive.
- Medicaid dental coverage for adults varies by state, and only thirty-three pay for restorative care (false teeth)
- The least expensive treatment alternative rule limits payments to low-end false teeth rather than pricier upgrades
Medicaid might pay for partial dentures subject to the two qualifications. A partial denture is a plate with one or more false teeth made of plastic or metal with clasps to keep the appliance in your mouth.
The coverage for partial dentures comes down to two issues.
- Payments in the states providing benefits for restorative care
- Limited to the low-price plastic base and metal clasps (not precision)
The cost of partial dentures with Medicaid rests on where you live and the appliance grade you would like to have fit and fabricated.
Determining whether your Medicaid plan will pay for immediate dentures is tricky because you introduce two additional caveats. The dentist fabricates temporary false teeth on the same day as the extraction to avoid a gap in your smile while your gums and jawbone heal.
The coverage for immediate dentures boils down to four questions.
- Does your state pay for the extraction of decayed teeth?
- Are the temporary replacements for cosmetic purposes only?
- Does your state provide benefits for restorative care?
- Does the extra cost violate the least expensive treatment rule?
Same-day dentures that accept Medicaid will prove challenging to find because you must meet all four criteria. The Dental Benefits Manager (see below) would be your best starting point.
Medicaid Denture Coverage by State
The state where you live is the primary factor determining whether Medicaid covers tooth-supported dentures in 2022 because the dental insurance component applies with these services.
Medicaid is a federal program, and each state has the latitude in deciding what benefits to support for oral care, what to name its program, and which private companies will administer claims.
Cost with Medicaid
The cost of dentures with Medicaid depends on the restorative care benefits offered by your state when you need tooth-supported appliances (most common).
Each state decides whether to pay for the initial installation, how often they cover replacements as your bone and gums shrink, and whether to impose an annual maximum benefit. As you can see, thirty-three currently pays something for false teeth, while seventeen do not.
|Covering Dentures||Not Covering Dentures|
Dental Benefits Managers
Private third-party companies called Dental Benefits Managers (DBM) adjudicate claims for each state and represent the final authority on whether your Medicaid plan pays for the type of tooth-supported dentures recommended by your provider.
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
Managed Care Organizations
Another set of companies called Managed Care Organizations (MCO) represents the final authority on whether Medicaid will pay for implant-supported dentures.
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
Branded names concocted by each state sow confusion for low-income adults wondering whether their Medicaid plan pays for dentures. 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 confound 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|