Generating a reliable list of oral and maxillofacial surgeons who accept your Medicaid plan is more involved than many think.
Medicaid has a dual nature. It has a health insurance component with consistent coverage nationwide and a dental insurance element with uneven coverage in each state for adults.
Meanwhile, oral surgeons are licensed physicians and dentists, and medical and dental insurance often cover their services.
The provider directory published by a Managed Care Organization or Dental Benefits Manager could be the ultimate resource. Learn where to start.
Oral Surgeons Accepting Medicaid for Adults
Finding an oral and maxillofacial surgeon in your area that accepts Medicaid for adults includes two tricks that can prove confusing. The right resource corresponds with whether the health or dental insurance component (if any) covers the procedure.
If your teeth are rotting and you have no money, you might need to find an alternative solution to your problem, as an oral surgeon could be overqualified to treat your condition.
Oral Surgery Coverage
The first trick to finding an oral surgeon that takes Medicaid for adults is determining whether the health or dental insurance portion will cover the claim.
Medicaid covers oral surgery for adults under the dental insurance element in thirty-one states and under the health insurance component across the country.
- Oral surgery for adults covered under health insurance when medically necessary: treatment of illness, injury, disease, disability, or developmental condition
- Reduction of broken jaw or tooth after trauma
- Corrective (Orthognathic) jaw surgery
- Removal of bone-impacted wisdom teeth
- Treatments for diseases affecting the jaw or neck
- Obstructive sleep apnea
- Temporomandibular joint dysfunction
- Oral surgery for adults covered under dental insurance when not medically necessary if a state-supported benefit
- Extraction of gum-impacted wisdom teeth
- Correction of underbites and overbites
- Drainage of abscesses
The second trick to finding an oral surgeon that takes Medicaid for adults is to reference the provider directory of the third-party company that will pay the claim. Your member ID card should include this information
- Managed Care Organizations (MCO) process claims for the health insurance component that addresses medically necessary care across the country.
- Dental Benefits Managers (DBM) administer claims for the dental insurance element – if supported in your state. The DBM could be any of these organizations as many operate in multiple regions.
- Managed Care of North America (MCNA)
- Delta Dental
Emergency Oral Surgeons Accepting Medicaid
The strategy for finding an emergency oral and maxillofacial surgeon located in your area that accepts Medicaid is straightforward because the coverage is uniform across the country for adults and children.
Emergency tooth extractions without insurance should not be a problem as long as the provider documents why the procedure needed immediate care.
Medicaid covers most urgent surgical care under the health insurance umbrella with consistent benefits nationwide. You should be able to find an emergency oral surgeon that takes your state insurance for these critical needs that require immediate attention.
- Procedures necessary to control bleeding, relieve pain or eliminate acute infections
- Services that are required to prevent “pulpal death” and the imminent loss of teeth
- Post-trauma operations: repair a broken jaw or remove broken teeth after a non-biting accident
Managed Care Organizations
The provider directory published by your Managed Care Organization (MCO) is the best resource to find an emergency oral surgeon that takes your Medicaid plan. An MCO is a private third-party company specializing in healthcare administration.
Find the MCO name on your member ID card and go to their website to find the provider directory. Input your zip code and select the correct specialty to get a list of participating providers in your area.
The MCO could be any of these organizations, as many operate in multiple states.
- 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
Pediatric Oral Surgeons Accepting Medicaid
Your ability to find a pediatric oral surgeon that accepts Medicaid is much better because the publically-funded program covers treatment more frequently. However, many low-income families find the state insurance names confusing.
Finding children’s orthodontists taking Medicaid for braces requires similar steps with a possible need to find craniofacial specialists.
A local pediatric oral surgeon who takes Medicaid is easier to find because the health insurance and dental insurance components are more consistent for children. Both work the same nationwide.
The Centers for Medicare & Medicaid Services (CMS) maintains an online directory of participating places for children.
Begin with their online dental office finder tool.
- Select your state
- Choose the plan
- Enter your zip code
- Check off accepts new patients
This CMS resource is not comprehensive and could be out of date. Therefore, it pays to double-check with the private company administering your plan.
State Insurance Names
Do not allow the fancy state insurance names to delay your quest to find pediatric oral surgeons that take your Medicaid plan. Many states concoct brand names for their programs, which complicates the issue for the low-income families they serve.
Your task is to identify the MCO and DBM associated with your plan and reference their provider directory if the CMS resource proves inadequate. Skip to the relevant sections if you stumbled across this article by searching one of these aliases.
|State||Brand 1||Brand 2|
|Illinois||Medical Card||Illini Care|
|Kentucky||Passport||KY Health Choices|
|New Jersey||NJ Family Care|
|New York||Healthy Choice|
|North Carolina||Health Choice|