Does Medicaid Cover Wisdom Teeth Removal for Adults 2022

Four sets of dual natures determine whether your Medicaid plan will cover wisdom teeth removal for adults in 2022.

First, Medicaid is primarily health insurance with uniform rules across the country and dental insurance with uneven benefits in each state.

Second, oral and maxillofacial surgeons are medical doctors and dentists performing procedures billed to health and or dental insurance.

Third, the extraction of bony-impacted third molars fits under the health insurance component, and removing their gum-impacted counterparts falls into the dental insurance element.

Finally, the Managed Care Organization (bone-impacted) or Dental Benefits Manager (gum-impacted) adjudicates claims and is the final authority.

Medicaid Coverage for Gum-Impacted Wisdom Teeth Removal

Medicaid might cover soft-tissue-impacted wisdom teeth removal for adults under the dental insurance element, depending on the oral surgery benefits in your state. These procedures are not medically necessary, so the coverage is hit or miss.

Dental grants for low-income adults might prove a more effective avenue if you live in one of the twenty-five states that does not support benefits for oral surgery.

State Benefits

Medicaid covers dental work for adults differently in each state. Two critical qualifiers determine whether your plan will pay for removing gum-impacted wisdom teeth: the age of adulthood and benefits for oral surgery.  

Age of Adulthood

Medicaid covers dental work for children throughout the country with probable support for soft-tissue-impacted wisdom teeth extraction. However, each state determines the age cutoff. Some stop at 18, while others continue until your child’s 21st birthday.

Most people have their wisdom teeth removed between the ages of 18 to 24, so a significant portion of low-income families can sneak by before their teenager becomes an adult as defined by their state.

Oral Surgery

Medicaid pays for gum-impacted wisdom teeth removal for adults over 21 when their state offers benefits for oral surgery. As of 2022, the coverage is available in twenty-five states per MACPAC. [1]

Support Oral Surgery

Exclude Oral Surgery

Arkansas

Alabama

California

Alaska

Colorado

Arizona

Connecticut

Florida

Delaware

Georgia

Illinois

Hawaii

Iowa

Idaho

Massachusetts

Indiana

Minnesota

Kansas

Nebraska

Kentucky

New Jersey

Louisiana

New Mexico

Maine

New York

Maryland

North Carolina

Michigan

Ohio

Mississippi

Oregon

Missouri

Pennsylvania

Montana

Rhode Island

Nevada

South Carolina

New Hampshire

South Dakota

North Dakota

Vermont

Oklahoma

Virginia

Tennessee

Washington

Texas

Wisconsin

Utah

Wyoming

West Virginia

Dental Benefits Manager

The Dental Benefits Manager (DBM) chosen by your state is the final authority determining whether your Medicaid plan will cover soft-tissue-impacted wisdom teeth.

A DBM is a third-party private company specializing in claims administration for the dental insurance element (if available). Find the DBM name from your member ID card and have the provider submit correspondence and claims information to them.

  • Dentaquest
  • Liberty Dental
  • Managed Care of North America (MCNA)
  • Delta Dental

Medicaid Covers Bony-Impacted Wisdom Teeth Removal

The health insurance component of Medicaid should cover bony-impacted wisdom teeth removal, regardless of the state where you live. The rules apply uniformly nationwide when treating an illness, injury, disease, disability, or developmental condition.

Medically Necessary

Medicaid pays for the extraction of bony-impacted wisdom teeth when medically necessary under the health insurance component. Jawbone-impacted third molars fit this definition because they can cause pain and infection and develop cysts.

Oral and maxillofacial surgeons perform these complicated extractions, and your plan should pay for all costs associated with these medically necessary services.

  • Extraction of partially or entirely bony third molars
  • Therapeutic drug injection (Dexamethasone)
  • Deep sedation (general anesthesia)
  • Panoramic radiographic image

Finding a local oral surgeon who accepts Medicaid for bone-impacted wisdom teeth removal should prove relatively easy. They are licensed physicians whose offices regularly bill health insurance plans for services rendered.

Managed Care Organization

The Managed Care Organization (MCO) chosen by your state is the final authority determining whether your Medicaid plan will pay for the removal of bony-impacted wisdom teeth.

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 oral surgeon to the MCO printed in bold letters on your member ID card.

Wisdom teeth removal is free when the MCO approves the claim. The overlap between states is confusing but worth the effort to unravel given the stakes.

  • 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

Branded names concocted by each state sow confusion for low-income adults wondering whether their Medicaid plan pays for wisdom teeth removal. 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.

State

Brand 1

Brand 2

Arizona

Care 1st

AHCCCS

California

Medi-Cal

 

Colorado

Health First Colorado

 

Connecticut

Husky

Connecticare

Georgia

Peach State Health Plans

 

Hawaii

Quest Integration

 

Illinois

Medical Card

County Care

Indiana

Hoosier Care

HIP Plus

Kentucky

Passport

KY Health Choices

Louisiana

Healthy Lousiana

 

Maryland

Medical Assistance

 

Massachusetts

MassHealth

 

Michigan

Medical Assistance

Healthy Michigan Plan

Minnesota

Medical Assistance

 

Missouri

Missouri Care

 

New Jersey

NJ Family Care

 

New York

Healthy Choice

 

North Carolina

Health Choice

 

Ohio

Buckeye Insurance

 

Oklahoma

SoonerCare

 

Oregon

Oregon Health Plan

 

Pennsylvania

Medical Assistance

 

South Carolina

Healthy Connections

 

Tennessee

TennCare

 

Texas

STAR

 

Virginia

Cover Virginia

Family Access to Medical Insurance Security

Washington

Apple Health

 

Wisconsin

BadgerCare

 

Article Citations:

[1] The Medicaid and CHIP Payment and Access Commission