Know Before You Go: Does Medicaid Cover Root Canals and Crowns?

The Information in this post is accurate as of October 19, 2021.

If you’re a Medicaid recipient, you might be a little unsure about your Medicaid benefits. For example, a lot of people wonder, “Does Medicaid cover root canals and crowns“?

The answer is that Medicaid allows for root canals and crowns in the 26 states where Medicaid covers Restorative Dental Care.

It’s essential to do your research when using your Medicaid coverage. Different plans in different states may cover different procedures. You’ll also need to find a dental professional that will accept Medicaid coverage.

In this article, we’ll take a deep dive into Medicaid dental coverage. By the end of this article, we hope to leave you with some clear-cut solutions on what to do for your dental needs.

So, stick around to the end and read along with us. By the time you’re done, you’ll be your family’s resident Medicaid dental expert.

Who knows? Maybe you’ll be able to help a friend or family member by referring them to this guide.

But we have a lot of information to cover, so let’s get going!

Medicaid Dental Coverage

Government programs like Medicaid and Medicare do a great job of covering major health expenses. Things like going to the emergency room, seeing doctors, and getting prescriptions are well taken care of. But, things can get a little confusing when it comes to coverages like dental and vision.

When it comes to dental, the coverage you receive changes based on your state. But, it can also change based on your age.

Dental coverage for children is guaranteed through Medicaid. Medicaid is required to include pain relief and infection treatment, tooth restoration, dental health maintenance, and any other medically necessary treatments for children.

For adults, however, the coverage is a little different.

Each state has different policies regarding what type of dental coverage it will give its Medicaid recipients. There is no minimum dental coverage requirement for adult care. As a result, less than half of the states in the U.S. choose to provide dental coverage to adults on Medicaid.

And, we’re not talking about cosmetic procedures. Unfortunately, less than half of America doesn’t provide emergency dental care to adults on Medicaid. But, don’t despair. There is hope.

The good news is that if you’re an adult on Medicaid, there may be other plans available to you to receive dental coverage.

Does Medicaid Cover Root Canals and Crowns?

A lot of people wonder, “Does Medicaid cover root canals and crowns”? Yet, these are important procedures that millions of Americans have to go through at some point in their life. They can be essential to an individual’s overall health, because if cavities are left untreated, they can lead to significant infection and severe illness.

Unfortunately, however, under Medicaid guidelines, these treatments qualify as “restorative care benefits.” These restorative care benefits are only available in 26 out of the 50 states in America.

Medicaid recipients need to be careful that their state’s dental coverage doesn’t put a cap on the number of procedures or cost reimbursement for these treatments, as well.

The golden rule here is to be sure you verify your individual benefits with any dental provider before incurring any costs.

Coverage for Crowns

Let’s take a look at what Medicaid may cover for crowns. Crowns are a cap placed over the tooth to repair the tooth’s size, shape, strength, and look.

There are several significant types of crowns dentists will use to repair your teeth. If you qualify for dental coverage through Medicaid, it may only provide coverage for the cheapest method available, and it may also put time limits on any replacement caps you may need moving forward.

Dentures

It’s important to talk about denture coverage as they fall into the same category as crown procedures. Dentures are removable plates that hold artificial teeth. People can use these appliances to replace missing teeth and fill in their smiles.

As a result, it’s primarily considered a cosmetic dental procedure.

As with all Medicaid procedures, coverage for dentures will vary from state to state.

Medicaid will typically cover the most cost-effective treatment available. You can pay out-of-pocket for a more advanced treatment (i.e., better crowns or dentures).

Coverage For Root Canals

Root canals are considered an endodontic dental procedure. This is because root canals deal with the soft tissue underlying the tooth itself. As a result, they aren’t as much of a cosmetic procedure as crowns or dentures.

The Medicaid coverage in your state may limit the number of root canals you can have in your lifetime. They may also limit the amount of money they will reimburse for the procedure.

Typical Medicaid coverage will allow for one root canal per tooth. They will usually exclude 2nd and 3rd molars, and they will also have a monetary limit on what they will cover.

Medicaid Dental Providers

The coverage available through Medicaid can make it a challenge to receive good care. Adding to that is the fact that most dental professionals don’t accept Medicaid coverage.

A recent survey shows that only about 43 percent of dentists throughout the country accept Medicaid coverage. Experts believe there are two main reasons for such a low amount of available dentists.

The first reason is that the Federal government makes it very difficult for dentists to become  “Medicaid-approved” providers. The second reason is that most Medicaid recipients that live in a state that provides dental care don’t know they are eligible to receive it.

The easiest way to find a dental provider that accepts Medicaid is to call the office you want to visit and ask. If they say no, don’t get discouraged. You still might be able to find a provider, and it just might take a little research.

When you first received your Medicaid coverage, you may have received a brochure outlining all the providers in your area. If you have it, you can consult this pamphlet to see which dentists near you will accept your coverage. However, if you don’t have access to that paperwork anymore, several online resources are available.

Search “Medicaid approved dental provider near me” or similar and see what comes up.

How To Find Dental Care

If you’re receiving Medicaid in a state that doesn’t provide dental care, you have other options. Also, many people who don’t qualify for Medicaid can’t afford other types of coverage. So they need options for coverage, as well.

There are a few reasons why someone might not qualify for Medicaid. The first reason is that their income is too high. Medicaid is only supposed to be for low-income individuals.

If you make over a certain amount per year, you’re excluded from the program.

Another possible reason is that Medicaid coverage wasn’t expanded in their state. The Affordable Care Act gave state governments directives on expanding Medicaid coverage for their residents. If your state chooses not to opt-in to these laws, you won’t be eligible for coverage.

The third reason might be your citizenship. If someone is not a legal citizen of the United States, they can’t qualify for Medicaid coverage.

Someone in any of these situations may be struggling to find dental coverage. It can be stressful, and they may not even know the options available to them.

Here is a quick list of places you can turn to in your search for the medical coverage you need.

Local Health Departments

The Bureau of Primary Healthcare is an organization at the Federal level. Their goal is to help low-income Americans receive the care they need. They do this by supporting federally-funded community health centers.

At these centers, Americans can receive discounted medical services. This includes free dental care for low-income households and families.

To find one of these centers, all you need to do is log on to the Health Resources and Services Administration web page. They offer an easy-to-use directory to help you locate the community organizations in your area.

Once you locate the center nearest to you, get in touch and ask them about all of the dental services they offer to low-income families.

Dental Schools

If there is a dental school in your area, you can get dental procedures done there at a discounted rate. Dental students reach a point in their curriculum when they need to practice on actual patients, and they do so supervised by their highly experienced instructors.

The ADA approves the school’s curriculum and instruction. As a result, a licensed dentist is present as students perform their dental procedures.

Solving the Medicaid Mystery

We hope this article answered, “does Medicaid cover root canals and crowns?” and you found some good information that will help you acquire the care you need.

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If you qualify for Medicaid benefits, you also qualify for Lifeline service. Lifeline is a federal benefit program that makes it possible for low-income consumers to receive access to free or heavily discounted communication services. Click here to find out more and apply for this valuable benefit.

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