Does Medicaid cover wisdom teeth removal?
Under certain circumstances, Medicaid may cover wisdom teeth removal for adults who live in specific states. Each state can determine which dental benefits to provide to adults enrolled in Medicaid.
A person can check their state’s Medicaid program for more information.
Medicaid is a program that provides health and medical services to low income households. Individuals who meet certain criteria are eligible for these services.
However, the eligibility criteria vary between states, and Medicaid plans do not all provide the same services under the same conditions.
Various state Medicaid programs offer comprehensive dental care for adults, while others provide limited or emergency-only dental services.
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Medicaid and wisdom teeth removal
This article originally appeared on Medical News Today
Medicaid typically covers dental services and care for children as part of the comprehensive Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
The EPSDT aims to provide extensive preventive, dental, mental health, and specialty services to children and people under 21 years old.
If a child needs their wisdom teeth removed, Medicaid will cover it. Medicaid may also cover wisdom teeth removal for adults who reside in specific states, under certain circumstances.
States and coverage
Medicaid dental coverage varies by state. Some states provide extensive dental care, while others provide limited or emergency-only care.
This section looks at which states may offer wisdom teeth removal.
Extensive dental care
States that provide extensive Medicaid dental care may cover the cost of wisdom teeth removal if the procedure is deemed medically necessary.
Wisdom teeth removal is not always medically necessary, especially if the teeth do not cause pain, damage, or health complications.
These states typically also provide various other dental care services, which may include various routine, preventive, and restorative treatments.
According to 2023 Medicaid statistics, states that provide extensive Medicaid dental care programs include:
Alaska
California
Colorado
Idaho
Illinois
Iowa
Maine
Montana
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
South Dakota
Virginia
Washington
West Virginia
Wisconsin
Limited and emergency-only dental care
States that provide limited or emergency-only Medicaid dental care may not cover wisdom teeth removal unless the procedure is necessary to treat severe health complications or a medical emergency.
A person can check their state’s Medicaid program to determine their level of coverage and whether they qualify for wisdom teeth removal.
States that provide emergency-only Medicaid dental care include:
Arizona
Florida
Hawaii
New Hampshire
Texas
States that provide limited Medicaid dental care include:
Arkansas
Kansas
Kentucky
Louisiana
Mississippi
Nebraska
Pennsylvania
South Carolina
Wyoming
Eligibility
Medicaid coverage eligibility for dental procedures varies by state.
Medicaid will not typically cover wisdom teeth removal or other dental procedures unless they are medically necessary.
The procedure may be medically necessary if the condition causes:
severe pain
damage or injury to the mouth
problems with functionality, such as biting and chewing
difficulty treating other conditions, such as cancer in the jawbone
a high likelihood of future complications
States that provide emergency-only Medicaid dental care may consider someone eligible for wisdom teeth removal under emergency circumstances, such as some types of tooth impaction.
An impacted wisdom tooth, which does not erupt through the gum properly, may sometimes constitute a medical emergency.
Impacted wisdom teeth could lead to severe complications such as:
However, a soft tissue impaction, in which gum tissue blocks the tooth from eruption, is not usually a medical emergency.
Costs
The Medicaid rate of wisdom teeth removal may range from about $60 to around $200 per tooth, depending on the complexity of the extractions.
Additional costs can include:
dental examinations
X-rays and other imaging scans
sedation
pain medication
follow-up appointments
Medicaid dental coverage
All states typically cover urgent or emergency dental care for people enrolled in Medicaid programs.
This may include dental care necessary to treat:
severe infections
severe pain
traumatic injury
persistent bleeding
dental concerns that could lead to severe health complications
Medicaid programs in states that provide extensive coverage may fully or partially cover other dental services, such as:
basic oral surgeries or procedures
preventive services, such as cleanings
restorative services, such as root canals
diagnostic services, such as oral examinations
A person can consult their state’s Medicaid program to determine their level of dental care coverage.
Some Medicaid programs may not cover dental care, except under urgent or emergency circumstances.
Others may require copayments, which require a person to pay a portion of the costs out of pocket.
Support for dental care
The following resources may help people reduce the costs of dental care:
Community clinics and dental schools: Some community clinics and dental schools offer services at a discounted rate.
Dental insurance: A person may want to discuss dental insurance with a health professional and a reliable insurance provider.
Dental savings plans: Dental savings plans can provide discounted rates for services within a network of health professionals.
Payment plans: Before undergoing treatment, a person can discuss the possibility of a payment plan with their dental professional’s office.
Medical credit cards: Some health professionals may accept medical credit cards, such as CareCredit.
Frequently asked questions
Does Medicaid pay for wisdom teeth removal in Florida?
The Medicaid program in Florida provides emergency-only dental care. A person may only qualify for wisdom teeth removal in an emergency situation.
What dental services are covered by Medicaid in NC?
North Carolina’s Medicaid program provides extensive dental care. It includes:
routine examinations
tooth restoration
oral surgery
preventive services
denture fitting and placement
periodontal services
Summary
Medicaid coverage varies between states.
Although children enrolled in Medicaid typically qualify for extensive dental care coverage countrywide, the extent of care varies for adults.
Some states provide extensive Medicaid dental coverage, while others provide limited or emergency-only coverage.
Medicaid may cover wisdom teeth removal in some states, and not in others. The decision may depend on whether the procedure is medically necessary and, in some states, whether it constitutes a medical emergency.
A person should check with their state’s Medicaid program to find out the extent of their dental care coverage.
View the original article on Medical News Today
