In recent years, widespread awareness has been growing of the critical connection between oral health and overall well-being. This includes the fact that poor dental health can lead to many serious medical problems.
In Medicaid expansion states, expanding dental benefits is associated with reduced non-traumatic emergency department and hospital-based dental visits.
Preventive Care
A growing body of research indicates that oral health is important for overall physical and mental health. In addition, dental care can help reduce overall health care costs by preventing complications that lead to expensive and often unnecessary medical treatments.
Despite these benefits, many adult dental insurance Medicaid Aberdeen recipients lack access to routine dental care. As a result, they may delay seeking medical attention, leading to increased use of emergency department services.
Economic evaluations can quantify trade-offs between the cost of a dental treatment and its impact on patient outcomes, which could inform decision making regarding whether to provide coverage for such treatments. However, this requires data that are specific to dental interventions and that include not only health care expenditures but also social welfare spending and quality of life outcomes.
Routine Exams
As a result of routine dental care, children can learn good oral hygiene habits and avoid problems like tooth decay. The American Dental Association recommends bringing kids to see the dentist for regular exams, cleanings and X-rays. Medicaid often covers these procedures for children.
Original Medicare doesn’t cover dental care, but does offer coverage in specific medically related circumstances such as surgery to treat jaw fractures, limited dental services to prepare for radiation treatment of oral cancer or an oral exam conducted in a hospital prior to kidney transplant. But 97 percent of Medicare Advantage plans include dental coverage, according to KFF.
Moreover, intellectual and developmental disability (IDD) Medicaid Managed Care plans provide coverage for sedation dental procedures.
X-Rays
Some dental insurance plans have frequency limits or require pre-authorization (precertification, predetermination) for X-rays. Getting familiar with your plan details can help prevent billing surprises.
Medicaid fee-for-service and managed care plan coverage varies across states. HMO and PPO plans usually have a network of participating dentists. These dentists are reimbursed at certain rates for services.
Some states have enhanced Medicaid dental benefits for specific groups of adult beneficiaries, such as pregnant women and people with special needs or health conditions. These enhancements are not captured in this year’s data used to create the Coverage Checker. However, many of these improvements are expected to continue into 2024.
Fillings
The federal government requires all states to provide dental services for children enrolled in dental insurance Medicaid Aberdeen and the Children’s Health Insurance Program through the Early Periodic Screening, Diagnostic and Treatment (EPSDT) program. This program helps identify problems and treat them before they become more serious.
However, for adults, Medicaid programs are not required to offer dental coverage. As a result, the extent to which states cover adult dental care varies across state lines.
Some states have taken steps to expand their dental coverage. This can include establishing access to community-based clinics that are able to provide comprehensive oral health care for Medicaid enrollees at significantly lower costs than private practice dentists.
Extractions
Many dental procedures, including extractions are covered by Medicaid as part of a comprehensive set of benefits for children known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
Coverage includes emergency oral surgery to treat severe infections, pain, bleeding or injuries. Medicaid will typically provide these urgent interventions if it can be shown that the patient faces serious health complications or death without immediate treatment.
However, it is important to note that cosmetic procedures are generally not covered. Also, dental coverage is often restricted for adults and annual or lifetime caps on coverage may apply. These limitations can impact access to vital oral surgery services.
