When not covered by insurance, a wisdom tooth extraction can be just as painful to your wallet as it is to your mouth.
Medicaid beneficiaries in some states may be able to find some relief. Below is a look at how Medicaid might cover the cost of a wisdom tooth extraction, depending on the state you live in.
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Most people have their wisdom teeth extracted before the age of 21, as the teenage years are when wisdom teeth typically appear. Medicaid dental coverage for those under the age of 21 is separate and different from how Medicaid covers dental care for adults.
Every state Medicaid program is required to provide some basic dental coverage for those under the age of 21.
These standards of care include:
They do not, however, include wisdom tooth extraction.
While no state Medicaid program is required to cover the cost of wisdom tooth extraction, many states go above and beyond the minimum coverage requirements set forth by the federal government. States can offer optional Medicaid benefits, which may include additional dental coverage.
The only way to know for sure whether or not your state Medicaid program will cover the cost of a tooth extraction for a child is to contact your state Medicaid program directly.
Unlike for children, state Medicaid programs are not federally mandated to provide any dental coverage for adults aged 21 and over. Each state determines if and how it will cover any dental services, and that includes wisdom tooth extractions.
Medicaid coverage of a wisdom tooth extraction in an adult may depend on whether the procedure is determined to be an emergency service or not. A wisdom tooth that is impacted and causing a great deal of pain may be considered an emergency and might be covered if the state Medicaid program covers emergency dental care.
The states that offer only limited dental coverage to adults and are thus less likely to cover a wisdom tooth extraction include:
The states that offer a little bit more dental coverage to adults and may be more likely to cover a wisdom tooth extraction include:
The states that offer “emergency-only” dental care coverage to adults and are likely to only cover a wisdom tooth extraction in an emergency include:
Only four state Medicaid programs, Alabama, Delaware, Maryland and Tennessee, do not offer any dental coverage for adults.
Medicaid beneficiaries who are also eligible for Medicare may be able to obtain coverage for a wisdom tooth extraction through their Medicare benefits.
While Original Medicare does not include dental benefits, Medicare Advantage plans may provide benefits not found in Original Medicare. One particular type of Medicare Advantage plan is called a Dual-eligible Special Needs Plan (D-SNP). These plans are specifically designed for people on both Medicaid and Medicare.
Connect with a licensed insurance agent to learn about any D-SNPs available where you live.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.