Does Medicaid Cover Dental Implants? Exploring Coverage Options
The Gist
Dental implants are an increasingly popular surgical approach to correcting oral problems like missing teeth, misaligned jaws, and more — but they can be very costly.
Most medical insurance plans consider dental implants a cosmetic procedure, so they may not be covered.
Medicaid, a government-subsidized health insurance plan for people with lower incomes, typically does not cover dental work for people over the age of 21.
Some states’ Medicaid plans cover dental or oral treatments, but it varies wildly based on where you live.
If you’re wondering how to get Medicaid to pay for dental implants, your first step is to get a doctor to declare the procedure medically necessary. This may require some back and forth with your state’s Medicaid office.
One easy way to lower your dental surgery and treatment bills is to get separate dental insurance. You can compare, shop, and even enroll right from Stride’s website.
In This Article
In Short
Comedy great George Carlin once said, “Everyone smiles in the same language.” Your smile can make a powerful first impression, but if you need dental implants, you might feel a little embarrassed when people see your teeth. First of all, you are beautiful the way you are.ut sometimes missing teeth can cause issues with chewing, oral comfort, and worse, so implants might be worth pursuing.
Most health insurance plans do not cover a majority of dental treatments, including dental implants. The same is true for Medicaid, a type of government-subsidized insurance for people with lower incomes. Depending on the state you live in, there’s a chance that Medicaid will cover some routine dental care, but dental implants are anexpensive procedure that requires an expert surgeon.
Keep reading for advice on how to get Medicaid to pay for dental implants, how to get low-cost dental insurance, and more — and keep smiling!
What Is Medicaid, and How Do You Qualify for It?
Medicaid is a government-funded health insurance program that’s offered to low-income Americans, people with disabilities, children, pregnant people, and the elderly. According to Medicaid.Gov, there are currently 87 million Americans covered by Medicaid plans. The funding for Medicaid comes from a combination of federal grants and state budgets.
Eligibility for Medicaid is determined by your modified annual gross income (MAGI). We put together a helpful guide and tool for calculating your MAGI here, but as a refresher:
Adjusted Gross Income = Total income - Personal deductions
Some common personal deductions that can lower your MAGI are:
Interest on student loans
Payments to self-employed health insurance
Contributions to IRA or similar savings plans
50 percent of self-employment taxes paid
Although it can vary by state, the Medicaid eligibility limit is typically 138 percent of the federal poverty level. This means your MAGI can be up to 38 percent higher than the federal poverty level, which for 2023 is $14,580 a year for an individual, with an increase of $5,140 for each additional person who needs coverage.
As of 2023, 138 percent of the federal poverty level is defined as having a MAGI of:
$20,130 for an individual
$27,214 for a family of two
+$7,084 for each additional family member (that means $48,493 for a family of five, $69,773 for a family of eight, and so on)
As always, with government-funded health care, it’s important to check with your local office for any questions about eligibility.
Does Medicaid Cover Dental Work?
Medicaid likely will not cover extensive dental work, visits, or surgery. There is a wide spectrum of what Medicaid will cover based on the state where you’re enrolled. For instance, Alabama, Maryland, and Tennessee do not provide any dental benefits through Medicaid. Other states, like Massachusetts, Ohio, and West Virginia, do offer extensive dental care through Medicaid, but may impose a cap of $1,000 of benefits in a single calendar year. Even further, there are certain states like Florida, Utah, and New Hampshire that only cover emergency dental care for Medicaid recipients.
If your state’s Medicaid plan doesn’t cover dental work or you think you’ll need major oral surgery (like dental implants) in the near future, we recommend shopping for an affordable dental plan with Stride. Simply enter your ZIP code and some health information, and you can even enroll directly from our site!
What Are Dental Implants and How Much Do They Cost?
There are a number of different dental implant products and procedures, but the long and short of it is that a dental implant is a false tooth attached to an anchor that is embedded into the jaw. Unlike dentures, which have to be removed and cleaned regularly, a dental implant is permanent and can be brushed just like the rest of your teeth.
The American Dental Association’s survey of fees found that an individual dental implant, which is made up of the anchor, an abutment, and a crown, can range from $3,100 to $5,800. These costs include your visits before and after the procedure, the cost of building the implant itself, and the surgeon’s time.
In most cases, health insurance does not pay for dental implants, as they are often considered cosmetic procedures. The cosmetic procedures classification includes certain plastic surgeries, skin treatments, and more. If your doctor deems it medically necessary, however, you may be able to have all or part of your dental implant surgery covered by your insurance.
Does Medicaid Pay for Dental Implants?
After reading all that, it’s easy to wonder, “Does Medicaid cover dental implants?” Unfortunately, the answer is often no. Depending on where you live, Medicaid might pay for certain dental procedures, but it’s unlikely that you’ll get full coverage for a dental implant. As with private insurance, you may be able to get your doctor to declare your dental implant surgery medically necessary.
Some reasons a doctor might declare dental implants medically necessary are:
If you lost teeth in an accident and the implants are part of a reconstructive procedure
If your missing teeth make it difficult to speak, chew, or sleep
If you are suffering other quality-of-life issues, like chronic jaw pain
As we mentioned above, some states might cap your total coverage at a set number, like $1,000 for a calendar year, so it’s important to know the ins and outs of your state’s Medicaid plans.
How Can You Get Medicaid to Cover Dental Implants?
As promised, here’s the part of this article where we explain how to get Medicaid to pay for dental implants. The easiest and most straightforward way is to be a Medicaid recipient under the age of 21. According to Health and Human Services, all states’ Medicaid plans are required to cover dental work for people under 21.
If you’re over 21, stop daydreaming about your misspent youth — we’re going to help you get dental implants! The first thing you’ll need to do is reach out to your doctor. Make an appointment with them and explain, in detail, the medical issues you’re having with your teeth, jaw, or mouth. Be honest and mention any discomfort you feel while eating, talking, chewing, or even just resting. If your doctor sees fit to recommend dental implants, they will then recommend a treatment plan and refer you to an oral surgeon.
You might need to work directly with your Medicaid office to make sure that you are collecting all necessary paperwork to make your claim go smoothly. Ask as many questions as possible along the way and take notes on who you speak with in case you need to reference the conversation on a future call. With any luck (and proper paperwork), you could be a few steps away from a life-changing dental implant!
Are There Any Programs That Can Help Cover the Cost of Dental Implants?
Medicaid does not cover dental implants, but you still have a few options when it comes to lowering your out-of-pocket expenses. You can consider a dental school where students and their instructors perform the procedure as part of their lesson plan. These facilities will often provide dental treatments at low (or no) cost. Look into getting dental insurance (more on this in the next section).
What’s the Best Way to Shop for Dental Insurance?
Hopefully, by now, we’ve answered your question, “Does Medicaid cover dental implants?” You may have also noticed how we keep mentioning separate dental insurance. If you only have Medicaid, there’s a good chance that you do not have coverage for dental care — especially oral surgery. Well, turn that frown upside-down, because we’re here to help.
If you lack separate dental insurance or think you’re going to need some procedures in the near future, now’s a great time to shop. Simply visit Stride’s website, enter your ZIP code and some basic information about your household, and in seconds, you’ll see dental plans curated just for independents like you. Compare policies to find the one that’s right for you or your family, and enroll right from our website.
We can’t wait to see your new smile.