Key takeaways:
Medicaid provides comprehensive dental benefits for children. But coverage for adults is optional and subject to limitations.
Many states and Washington, D.C., have expanded Medicaid programs to offer more comprehensive adult dental coverage.
Only a few states provide emergency-only dental coverage for adults on Medicaid. This typically includes urgent needs such as infections or severe tooth pain.
Dental care can be a major financial burden for many Americans. A KFF poll found that nearly half of U.S. adults put off or avoid dental services because of cost.If you meet the income requirements, you or your family may qualify to receive dental benefits through Medicaid. Medicaid is a state-run program that provides free or low-cost healthcare coverage to eligible individuals.
All states are required to offer comprehensive dental benefits for children and young adults under age 21 through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. For adults, however, dental coverage through Medicaid is optional and varies by state.
Does Medicaid cover dental care for adults?
Medicaid dental coverage for adults is not required by federal law, so each state decides whether to offer it. As a result, the type and amount of coverage varies widely. Medicaid does not mandate any minimum level of dental benefits for adults. But 49 states and Washington, D.C., offer at least some dental coverage for adult enrollees.
Coverage is generally limited to preventive or medically necessary services. Cosmetic or experimental dental procedures are typically not covered. It’s important to contact your state’s Medicaid office to understand exactly which services are covered and which restrictions may apply.
What dental care does Medicaid cover for adults?
Many states have expanded dental coverage for adults through Medicaid. But the type and amount of coverage varies widely and may change from year to year. Some services may also require prior authorization. This means you’ll need approval before getting certain treatments.
There’s no official national source that clearly outlines which states offer extensive, limited, or emergency-only dental services through Medicaid. Because there’s no standardized definition for these terms, it can be difficult to compare coverage from one state to the next. We reviewed individual state Medicaid policies to give you an idea of what type of coverage each state may provide.
Below is a general breakdown of coverage types by state. Keep in mind that Medicaid policies are updated frequently. It’s always a good idea to check with your state’s Medicaid office or website for current information.
Extensive coverage
Many states and Washington, D.C., offer extensive or comprehensive adult dental care. According to the American Dental Association, extensive care covers over 100 preventive and diagnostic procedures. That includes minor and major services costing at least $1,000 per person. The following places offer extensive adult dental coverage through Medicaid:
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Limited coverage
Some states offer limited dental coverage for adults through Medicaid. This typically means the program covers fewer than 100 dental services, which may include routine checkups, cleanings, fillings, and minor dental procedures. In some cases, coverage is even more restricted. For example, Missouri limits adult dental benefits to services related to trauma involving the mouth, jaw, teeth, or surrounding areas.
Coverage limits vary. Many states cap benefits at around $1,000 per person each year; some offer less. For instance, Arkansas limits adult benefits to $500 annually. States with limited coverage include:
Georgia
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Emergency coverage
A few states offer emergency-only dental care for adults on Medicaid. That means they cover only urgent dental situations, such as treating infections or severe tooth pain. These states include:
Nevada (prior authorization may be required)
Texas (some managed care plans offer limited additional benefits)
Adults 21 and older will qualify for emergency dental services in most states. All states provide dental services for adults during pregnancy. As of October 2022, Alabama provides dental benefits only to Medicaid recipients over 21 during pregnancy and postpartum. But services must be provided by Medicaid-enrolled dental professionals. Check the Medicaid program in your state to see which adult dental services are covered.
Does Medicaid cover dental care for children?
Yes, it’s federal law. All states must provide dental services to children and young adults under age 21. That includes anyone enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). This dental benefit is part of the EPSDT initiative. The program works by identifying problems early and treating them quickly. Every state must include EPSDT in its Medicaid program.
As a rule, all dental coverage for children must include treatment related to:
Maintaining dental health
Relieving pain and infections
Treating emergency conditions
In addition, Medicaid dental benefits for children may cover preventive services like:
Checkups
Cleanings
Sealants
Other Medicaid benefits for children may also include restorative services like:
If a problem is detected during a dental screening, states must provide the necessary care to treat it — even if it’s not typically covered. Medicaid also requires that children see a dentist regularly. Each state determines the frequency, but the time between visits must be reasonable.
Do all states provide dental coverage?
Yes. All 50 states and Washington, D.C., provide at least some dental services through Medicaid. Recipients under 21 receive full dental benefits in every state. But each state has the power to decide how much dental care, if any, it will offer to adults on Medicaid.
How to use Medicaid for dental care
Here’s how you can get dental care through Medicaid:
Check your state’s Medicaid website to determine which dental services are covered.
Find a dentist who accepts Medicaid. You can call your Medicaid dental plan or visit the Medicaid website.
Make an appointment with the dentist.
Bring your Medicaid ID card and any other required documents to your appointment.
Your dentist will provide services, and Medicaid will cover the cost.
Who qualifies for Medicaid?
The Affordable Care Act changed how people can qualify for Medicaid. This may help you become eligible for Medicaid based solely on your income. To qualify for Medicaid, you must meet state and federal requirements:
Be a U.S. citizen or a legal resident with a valid immigration status
Have an income at or below your state’s eligibility limit, which is often based on a percentage of the federal poverty level
Fall into an eligible category, such as being pregnant, having a disability, or being a child or an adult caring for a child
Live in the state where you’re applying for Medicaid
Also, keep in mind that income requirements can change from year to year.
In general, you can sign up for Medicaid in two ways:
Through the health insurance marketplace
Directly through your state Medicaid agency
You can also go to healthcare.gov, take a short quiz, and see if you qualify for Medicaid or other health insurance options.
From January 2020 to March 2023, people with Medicaid could keep their benefits without having their eligibility reviewed. This was because of the COVID-19 pandemic. But as of April 2023, individuals must show proof of eligibility. This is known as Medicaid unwinding.
Dental care resources for those without insurance
Adults without dental insurance might have a hard time accessing dental care. But there are many ways you can save money on dental care even if you don’t have insurance:
Buy a dental savings plan. Research dental savings plans online and explore the benefits. You’ll get a discount card and pay a discounted rate for services from a network of dentists.
Look for a community health center. To find a clinic near you, check the HRSA Data Clearinghouse or contact your local health department.
Try negotiating. You may be able to lower your dental bill just by asking, or you can also request a payment plan.
Use your health savings account (HSA). You own your HSA even if you no longer have insurance. To use your HSA without paying a penalty, your dental treatments must fall under the IRS criteria for qualified medical and dental expenses.
Visit a dental school. Dental students, who are supervised by a faculty dentist, can cost up to 50% less, depending on where you live and the clinic you visit. Check the U.S. dental school directory.
Frequently asked questions
It depends. Blue Cross Blue Shield (BCBS) medical plans typically don’t cover dental implants. This is because they are considered a dental procedure, not a medical one. But if you have a BCBS dental plan, coverage varies. Some plans exclude implants entirely. Others may cover them, especially if they’re deemed dentally necessary and the least costly appropriate treatment. In some cases, crowns or prosthetics placed over implants may be partially covered even if the implant itself is not. Always check your plan details or contact BCBS directly to confirm.
No. Family planning Medicaid benefits do not cover dental care. This program is designed to provide services related to family planning, such as birth control, counseling, and screenings for sexually transmitted infections.
Yes. Medicaid covers cavity fillings for children in all states. This is part of the required dental benefits under the EPSDT program. For adults, coverage varies by state. Some states offer full dental benefits, including fillings. But others may cover only limited or emergency dental care.
It depends. Blue Cross Blue Shield (BCBS) medical plans typically don’t cover dental implants. This is because they are considered a dental procedure, not a medical one. But if you have a BCBS dental plan, coverage varies. Some plans exclude implants entirely. Others may cover them, especially if they’re deemed dentally necessary and the least costly appropriate treatment. In some cases, crowns or prosthetics placed over implants may be partially covered even if the implant itself is not. Always check your plan details or contact BCBS directly to confirm.
No. Family planning Medicaid benefits do not cover dental care. This program is designed to provide services related to family planning, such as birth control, counseling, and screenings for sexually transmitted infections.
Yes. Medicaid covers cavity fillings for children in all states. This is part of the required dental benefits under the EPSDT program. For adults, coverage varies by state. Some states offer full dental benefits, including fillings. But others may cover only limited or emergency dental care.
The bottom line
Medicaid programs provide affordable dental care for individuals with low incomes. Dental care benefits are mandatory for people under 21 but optional for adults. Most states provide extensive coverage for all Medicaid recipients. But a few offer only limited or emergency dental services for adult members. Even if you don’t have insurance, you can still save money on dental services. Resources like dental savings plans or community health centers may help lower costs.
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