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Getting Dental Care When You Have Medicaid or Marketplace Insurance

July 30, 2018

Getting dental treatment is an essential part of good health, but many people get discouraged when trying to figure out what’s covered and how to get it.  Here are a few basics on how to find out what’s covered under your plan:

If you have insurance through the Health Insurance Marketplace (Affordable Care Act or Obamacare):

All dental plans are separate from health plans and must be purchased separately at the time of enrollment. If you’re picking a plan, be aware of what type of coverage you choose.  The lowest-cost plans will only cover basic care.  Plans that cover more will cost more, but it may be worth it if you anticipate needing extensive dental care.

To find out what your plan covers, check out your plan’s brochure, which should have a list of services and costs.

If you have Medical Assistance (Medicaid):

Medicaid offers dental coverage. Basic coverage includes yearly exam and twice-yearly cleanings.

Certain follow up care can be obtained easily such as fillings for cavities, but other care may require more paperwork.  There are different kinds of paperwork called “prior authorizations” and “benefit limit exceptions.”  You may need to provide documentation from your dentist and sometimes your primary doctor to show why a service is important and will help you take care of your oral health, which translates to part of your overall well-being.

Here are some more examples of services which are covered, but require paperwork to get approved:

  • orthodontics
  • dentures
  • extractions
  • crowns

For a more comprehensive list of covered services and information about the processes required to get them approved, as well as information about our campaign to advocate for better dental coverage through Medicaid, visit myteethmatter.org

To find out what dentists are covered, call your MCO or go to enrollnow.net.