Dental cover is important to have. You never know when you might have a dental emergency, and they can be extremely costly if you don’t have the right cover.
But dental insurance can also be expensive, and if you aren’t financially secure or have a low income then finding dental cover can be hard.
Luckily, there are still some ways you can protect your smile without worrying about breaking the bank.
AHCCCS is the state of Arizona’s Medicaid agency, and is intended to subsidize medical costs for individuals with financial need, and provides low-cost or free healthcare to people who qualify.
But does AHCCCS provide dental cover? Don’t worry, because we have all the answers right here!
In this handy guide, we’ll take you through whether or not AHCCCS covers dental so you know if you don’t have to worry about dental emergencies breaking the bank.
We’ll also take a look at the coverage it provides, as well as how you can qualify for dental with AHCCCS.
Table of contents
What Is AHCCCS?
First of all, let’s take a look at what exactly AHCCCS is. AHCCCS stands for the Arizona Health Care Cost Containment System, and it is the agency that runs Arizona’s Medicaid program.
The AHCCCS is used to help low-income individuals in Arizona to manage healthcare costs by partially or completely subsidizing the cost of healthcare.
The parameters to qualify for AHCCCS are quite strict, and not every form of healthcare can be fully subsidized through the program.
This includes costs above a certain limit, as well as the types of healthcare that AHCCCS covers.
So where does dental cover come in?
Does AHCCCS Cover Dental?
The short answer is yes, AHCCCS does cover dental. However, this comes with some caveats that mean not all procedures are fully covered, and there are certain guidelines that are specific to dental cover.
Additionally, there are limits to the amount that AHCCCS will cover in terms of dental costs.
While AHCCCS typically has no out-of-pocket costs, the rules are slightly different when it comes to dental cover.
One of the main factors that determine the cover offered by AHCCCS is that only medically necessary procedures are covered by the program.
While this means that dental emergencies will generally be covered, many procedures won’t be.
Additionally, the guidelines for the coverage provided, as well as the amount that AHCCCS provides, can be restrictive in some cases.
While all medically necessary procedures for qualifying children under the age of 19 are free through AHCCCS, members aged 21 and over only receive coverage up to costs of $1000 per contract year.
Additional costs won’t be covered, and non-medically necessary procedures won’t be covered at all.
The reason this can make dental cover tricky is that some dental procedures are seen as not medically necessary, despite still needing to be done.
These include services like cleaning and X-rays, and even procedures like extractions needed for fitting braces.
Because some of these services can come alongside covered procedures, it can be hard to know exactly which parts of your dentist visit are covered by AHCCCS and which services aren’t.
What Dental Cover Does AHCCCS Provide?
To help clear up the confusion, let’s take a look at which dental services are covered through AHCCCS.
As we’ve already mentioned, all medically-necessary procedures for qualifying children under the age of 19 are completely subsidized through AHCCCS.
This means that if your child has a dental emergency and they qualify for AHCCCS cover, you won’t have to pay anything out of pocket.
However, children aren’t covered for non-medically necessary treatments either and you’ll have to cover the cost of these yourself.
Qualifying adults over the age of 21 will have their costs for emergency dental services and medically necessary procedures subsidized for up to $1000 every contract year.
This includes coverage for the treatments themselves, along with other required services such as X-rays and examinations.
The types of dental procedures that are covered by AHCCCS include necessary surgeries, treatments of infection and acute pain, and treatment of jaw fractures.
AHCCCS will also cover the costs of examinations of the oral cavity, anesthesia, required X-rays, and necessary medicines (including antibiotics and painkillers).
However, there are many things that AHCCCS won’t provide coverage for. Several dental procedures are classed as cosmetic and therefore aren’t covered by AHCCCS.
These include fillings, braces, dentures, and other preventative or restorative procedures. Because these aren’t covered through the program, you’ll have to pay out of pocket for these services.
How Do You Qualify For AHCCCS Dental Cover?
AHCCCS dental cover can be a massive help for individuals and families who qualify for the aid.
However, the parameters for qualifying for AHCCCS can be pretty stringent, and you must hit several guidelines in order to receive AHCCCS dental cover.
The main factor that determines whether or not you qualify for AHCCCS coverage is your income.
In order to receive AHCCCS dental cover, an individual must have an annual income of 138% or below the Federal Poverty Level.
This translates to a maximum of $17,774 in annual income for an individual, or $36,570 for a family of four.
This is a bit less strict when it comes to children’s coverage, and children below the age of 18 can qualify for AHCCCS coverage if their family is at or below 205% of the Federal Poverty Level (or below $54,325 for a family of four).
You must also be a U.S citizen below the age of 65 in order to qualify, and you can’t be eligible or enrolled in Medicare already.
As long as you meet these requirements, you can take advantage of AHCCCS dental cover!
AHCCCS dental cover is an important program for low-income individuals and families in Arizona, and provides helpful subsidies to cover the costs of emergency dental care when people need it most.
If you qualify for AHCCCS and you’re worried about dental costs, then enrolling in the program is a great way to reassure yourself that you won’t break the bank if you have a dental emergency!
Frequently Asked Questions
As of 10/12017, members 21 years of age and older have a $1,000 dental benefit per member, per contract year to cover emergency dental care and extractions.
Arizona adults who are enrolled in MediCaid Access receive emergency dental care. Medicaid in Arizona does not cover exams, x-rays, cleanings or other preventive dentistry. The annual limit for emergency dental is $1000.
AHCCCS is Arizona’s State Medicaid Program. AHCCCS Members who also have Medicare are called Dual Eligible Members. Being enrolled in the same health plan for Medicare and Medicaid is called “alignment.” Alignment provides: • One plan that coordinates all care.