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.
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.
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Every state Medicaid program is required to provide some basic dental coverage for those under the age of 21. These standards of care include basic maintenance of dental health, teeth restoration and relief of pain and symptoms from illness or injury. 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, there is dental coverage found in most Medicare Advantage plans. And 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 and come with $0 premiums and often include coverage of both routine and advanced dental care.
Connect with a licensed insurance agent to learn about any D-SNPs available where you live.
Speak with a licensed insurance agent
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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