Medicaid is a godsend for those of us who have fallen on hard times. This could be for a number of reasons, from losing our jobs to being injured in accidents.
Each of these reasons is valid, and when you begin losing everything due to not having the resources or ability to access health care, then Medicaid is there to help you out.
The problem is that it is a federally funded program designed to help those who truly need it, as such limits and restrictions have been put in place on the amount of funds able to be given away and to stop this system being abused.
As such, some things are not covered by Medicaid, however the government isn’t great at clarifying what these are.
One of the big questions is how far the dental coverage of Medicaid will go. Does Medicaid cover dental implants? And if not, why?
In this article, we seek to answer this question and clarify how much dental your Medicaid will cover.
Table of contents
- What Is Medicaid?
- Who Benefits From Medicaid?
- How Does Medicaid Work?
- What Happens After The Procedure?
- Is There A Maximum Dollar Limit For Any One Procedure?
- Does Medicaid Cover Dental Implants?
- Is There Any Way To Get Dental Implants Through Medicaid?
- Other Ways To Pay For Dental Implants
- Frequently Asked Questions
What Is Medicaid?
Medicare is an insurance program run by the US Government which covers health care costs for people over 65 years old and under certain circumstances younger people.
The idea behind Medicare is to provide healthcare for all Americans regardless of income, but because it is administered by the US government, there are rules and regulations concerning eligibility and how it works.
Medicaid is also a federally funded healthcare program run by the US government.
It provides medical assistance to low-income families with children and adults.
As mentioned above, it has its own set of rules and regulations regarding eligibility and how it works, but it does allow for more flexibility than Medicare.
Who Benefits From Medicaid?
Anyone who qualifies can apply for Medicaid. The only requirement is that they meet income requirements.
This means that anyone who makes less than $16,955 per year (as of 2018) and is under age 65 is eligible for Medicaid.
Some states do not require people to work, so they may receive benefits even if they don’t work.
In addition to meeting income requirements, applicants must also meet residency requirements.
They cannot live outside their state of residence unless they qualify for long term care services through another program.
If someone meets both criteria, they are automatically enrolled into Medicaid.
If they aren’t already receiving other forms of welfare, they can sign up for Medicaid online. However, they must first fill out an application.
Once approved, they will be enrolled within 3 days. Medicaid doesn’t pay for anything else besides healthcare.
There are no other services, like food stamps, housing subsidies or child support payments available.
How Does Medicaid Work?
Once someone is enrolled, they will be provided with healthcare coverage. This starts with them getting a card that shows their current status.
They will then be assigned to a Primary Care Provider (PCP). These providers will include doctors, dentists, nurse practitioners and physician assistants.
All PCP must accept Medicaid patients. They should be familiar with the benefits and limitations of Medicaid.
If a patient decides to get a procedure done, they will have to request a referral from their PCP.
They will need to schedule the appointment and give notice to their PCP. Their PCP will then make arrangements with the provider.
Most providers will see Medicaid patients on an emergency basis as well. Some procedures are considered elective.
These include cosmetic surgery, such as breast augmentation or liposuction, and non-cosmetic procedures, such as hip replacement.
Elective procedures are usually not covered by Medicaid, due to the consideration that it is not necessary to improve the standard of a person’s life.
While this is not agreed upon for some procedures – hip replacements being the main one – it is currently the case with the Medicaid regulations.
Other procedures are considered medically necessary. These include surgeries, root canals, crowns, and extractions.
Medically necessary procedures typically have full to partial coverage, due to their direct effect on a person’s life.
When they are performed, the patient will have to pay a deductible and coinsurance before the rest of their bill is paid.
The difference between these two types of procedures is based on what type of health insurance the patient has.
If the patient had private insurance, they would likely be covered for all of their costs.
However, with Medicaid, there are limits on what can be charged.
What Happens After The Procedure?
After the procedure is complete, the patient will go back to the provider’s office.
They will provide documentation and verification of the service. After this is completed, the provider will submit the claim to Medicaid.
Depending on the amount being billed, it could take anywhere from 2 weeks to several months.
In most cases, the provider gets reimbursed at a lower rate because of the limited amount of time needed for the billing process.
After the reimbursement is received, the provider sends a check to the patient. The patient then pays the remainder of their bill.
Some providers may require additional paperwork, depending on how much was spent.
Is There A Maximum Dollar Limit For Any One Procedure?
Yes. Each state sets its own maximum amounts. For example, Florida requires $1,000 per year for medical expenses.
Any amount above this is considered over utilization. Medicaid also places caps on the total amount of money that can be spent on any single procedure.
These ranges vary from provider to provider. For instance, a dentist might only allow you to spend $500 per visit.
A dermatologist might not allow more than $2,500 per month. These restrictions prevent providers from charging excessive fees.
This helps keep down overall costs. Because of this, many people prefer to use a primary care doctor rather than a specialist when possible.
Does Medicaid Cover Dental Implants?
No. Dental implants are considered long term prosthetics and as an elective surgery.
As mentioned earlier, Medicaid does not generally cover elective procedures.
The reason that dental implants are considered elective is that dentures and false teeth are available and since there are cheaper alternatives that improve your quality of life, they are not necessary.
It’s important to note that some states do offer dental services under Medicaid.
For example, New Jersey provides dental benefits to low income residents.
It also offers special funding programs aimed at elderly and disabled individuals. However, dental implants aren’t listed among the available benefits.
This means that if your state doesn’t offer dental services through Medicaid, you’re out of luck. You may want to consider using another form of financing instead.
That way, you can still afford the treatment you desire without having to worry about paying for it later.
Is There Any Way To Get Dental Implants Through Medicaid?
Unfortunately, the answer is not really. There are very few ways to get dental implants through Medicare or Medicaid.
Most dentists don’t accept them either unless you have absolute proof of your coverage.
If you have a significant and documented need for dental implants, then Medicaid might cover it, but you are in for an uphill struggle to get it recognized.
If you have a high deductible plan, you may qualify for dental coverage. Check with your insurance company to see what options you have.
Other Ways To Pay For Dental Implants
There are other methods of getting dental implants besides Medicaid. One option is to pay for the procedure in full up front.
Alternatively, you may choose to finance your treatment. Both of these options work well for those who need immediate access to funds.
Another method is to get a company credit card. Many companies now offer this kind of card.
This is useful for patients who don’t qualify for Medicaid but still need to pay for dental implants.
The benefit here is that you’ll only have to make one payment, and you won’t have to worry about how much you will owe after the service is performed.
Instead, you’ll simply receive a bill each month. When you pay off the balance, you’ll never have to think about the cost again.
You should always check the fine print before signing anything.
Make sure that you understand all the terms and conditions so that you aren’t surprised by unexpected charges.
Getting dental implants can sometimes be necessary to improve your quality of life.
It may seem like making a mountain out of a molehill to others, but when you have lost the ability to chew and swallow properly, this small surgery can mean the difference between a happy life and one filled with pain and misery.
It may be very hard to do on just Medicaid, but there are a few alternatives to consider as well.
Unfortunately, if you are only using Medicaid, you will have to go through a few real chores to try to make it work.
Frequently Asked Questions
Using your New York Medicaid card, you can receive these services without prior approval:
-Emergency care, including treatment for pain or infection;
-Oral examination and treatment plan;
-Periapical, bitewing, occlusal, and extraoral X-rays;
-Preventative care, including cleaning and polishing;
New York must cover root canal dental treatments for Medicaid patients under legal settlement.