Does Medicaid cover Wisdom Teeth extraction is the question we often get asked, especially in Las Vegas. The short answer is…It does.
Wisdom teeth are the last teeth to erupt in the mouth, and when they do, there may not be enough space for them to occupy. This causes them to erupt in abnormal positions or not erupt at all, causing pain and infections if left untreated.
For these reasons, wisdom teeth removal can be an emergency treatment to alleviate pain or as a precaution to prevent future dental issues.
The cost of removing your wisdom teeth can be expensive and so using a health insurance plan like Medicaid is advisable to cover treatment. Medicaid is available and will cover all the cost of your wisdom teeth extraction.
Medicaid, which may be provided under several brand names, can cover the extraction of wisdom teeth under some conditions such as the age of the patient and type of Impaction, which vary from one state to the other.
Reading this article will give you information on dental coverage by Medicaid and if the cost of removing your wisdom teeth will be covered.
Is Wisdom teeth removal covered by Medicaid?
Medicaid covers a range of dental services which vary from state to state in the U.S. Depending on where you’re located, Medicaid could pay for wisdom teeth extraction but the extent could be based on the age of the user and the type of wisdom teeth Impaction.
In states where benefits of dental care are not compulsory, Medicaid may only cover emergency wisdom teeth removal in adults since the plans are generally for children and young adults under 18 or 21 years.
So if your child is under 18 or 21 years, as directed by the state, they could have their wisdom teeth removed covered.
Federal laws require Medicaid programs in states to provide dental health benefits to children under 18 and so you can rest assured that the program will cater to your child’s wisdom teeth removal whether it is an emergency or not.
Medicaid Coverage for Bony Wisdom Teeth Impaction
Regardless of your state, Bony wisdom teeth Impaction is considered a dental emergency because this can lead to pain, infections, and cyst formation. The Health Insurance component requires Medicaid to cover the extraction of bone-impacted wisdom teeth because they fit into the description of being medically necessary.
The plan should cover the costs incurred by the oral and maxillofacial surgeon including:
- • Panoramic Radiographs
- • General Anaesthesia
- • Localised anesthesia and medications
- • Surgical extractions of partially or submerged third molars.
Licensed practitioners who utilize health insurance plans for cost coverage will most likely use Medicaid and you can have your wisdom teeth extraction done by them.
Medicaid Coverage for Soft Tissue Wisdom Teeth Impaction
Medicaid programs in states are not mandated to include dental services in their plans and as such only select states include them in their insurance plans. Minimum requirements are also not present in states that provide Medicaid and so most have flexibility in covering dental services for adults.
Medicaid in some states might cover impacted teeth caused by fibrous gum. Though not deemed as an emergency, the dental benefits within the state may cover costs for adults with gum-impacted wisdom teeth.
This also has limitations as the age for such maybe 18 years while some may cover up to 21 years. Since wisdom teeth are generally removed between 18 to 24 years, people who may not be able to afford the cost of wisdom teeth extraction can seize the opportunity within that age frame.
As of 2022, there are about 25 states that offer coverage for teeth Impacted by soft tissue. These are:
12. New Jersey
13. New Mexico
14. New York
15. North Carolina
18. Rhode Island
19. South Carolina
20. South Dakota
Medicaid could be provided under brand names which may be confusing to users so ensure that you check with your service provider to know the brand name Medicaid could be provided in your state.
Unfortunately, some states do not include oral surgery costs in their Medicaid plans, so removing gum-impacted wisdom teeth would be funded out of your pocket. These states are: (this list may be old so make sure to call the office)
19. New Hampshire
20. North Dakota
25. West Virginia
So if you require dental service in any of these areas, you might want to consider other insurance plans tailored towards Adults or just plan to pay out of your pocket.
What Dental Packages for Children are Included in Medicaid?
Your child may be screened orally during a general physical examination. This screening in no way replaces examinations done by a dentist and so your child is required to see a dentist for comprehensive oral health care.
As part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, Medicaid is mandated to provide care to children with conditions that have been deemed necessary.
If a screening is conducted on a child and a condition that requires urgent attention is discovered, the state is required to provide medical or dental care for the child regardless of if Medicaid covers it or not.
There are basic dental benefits that the State Medicaid plan is expected to cover regardless of the age of the child.
The Benefits children can receive include:
• Routine Dental cleaning and hygiene maintenance
• Restorations of cavities on teeth
• Pain relief and management of Dental Infections
State Medicaid plans are not limited to these minimum requirements for children. Many have other dental benefits which could sometimes include wisdom teeth extraction for children under the age of 18.
You could also check with your local office on any restrictions on their services and if there are adult plans that could partially cover wisdom teeth removal for young adults under 21 years.
How Much Does Wisdom Teeth Removal Cost?
Wisdom teeth are expected to erupt in the mouth around 18 to 24 years. They are also the last teeth to erupt and in people with particularly small jaws and larger teeth, there may not be enough space for them to erupt which can cause problems.
The teeth can grow in incorrect positions or not at all. This is when it becomes impacted and wisdom teeth Impaction can cause Tooth pain, Gum Pain, and swelling. In this case, removing it will be the best option.
Removal of non-impacted wisdom teeth is not as hard as Impacted teeth which can be more challenging and sometimes require the skills of a specialist.
With these factors considered, routine extraction of wisdom teeth can cost about $70 to $200 while extraction of Impacted wisdom teeth can run as high as $1000 depending on the type of Impaction.
States which include dental services either as emergency or essential have annual limits on how much they cover. These limits can also run into $2000 so you should check with your health care provider on the limit and period it covers.
What Measures have been taken to increase Medicaid Dental coverage?
Through Medicaid, people who would have otherwise found it hard to access dental care due to low funds have access to it. Though not mandated by federal laws, state Medicaid programs are accessible to adults who need them.
The downside is that these dental services are most times not regulated and as such are different from one state to the other and also change yearly. This inconsistency makes it difficult for Medicaid users to know what benefits are included within the state per year and would warrant frequent visits to service care providers.
Due to this, strategies are being put in place to regulate Medicaid dental services and improve its coverage in the U.S. These include:
1. Providing higher reimbursement rates and incentives to increase Dental service providers who utilize Medicaid. This encourages Dentists to incorporate Medicaid as their service provider.
2. Encouraging participation between health centers in communities that have little to no plans for Dental care accessibility. This brings Dental services to communities that may be underrepresented and have little access to dental care.
3. Encouraging Teledentistry to maximize dental care delivery in states like California. Medi-Cal covers dental consultations done online and services that a hygienist would provide.
4. Providing reimbursement of student loans up to $45,000 for dentists who are willing to work for two years in approved regions where dental service is underrepresented. This could serve as an incentive for dentists to provide services for patients who use Medicaid.
Wisdom teeth can require removal under given conditions and Medicaid coverage makes getting treatment more accessible and affordable. Ask your licensed Dental practitioner and find out if Medicaid is included in their insurance plans.
You should also be aware of the requirements of your state Medicaid plan and their annual limits because they change yearly.