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