Does Medicaid cover wisdom tooth extraction? It depends on several criteria, including your state of residence and your exact Medicaid plan.
When it comes to oral care, a whole range of services are included.
Wisdom teeth removal is one such service. If you’re on Medicaid, you might want to determine if this service is covered. So, does Medicaid cover wisdom teeth removal?
This will be the focus of our discussion.
If you’re reading this, chances are you seek answers to the question or are simply interested in knowing. Whatever the case is, we’ve taken the time to provide all the correct answers.
By the end, you should be ready to take action by exploring your options. Without delay, let’s get to business.
Medicaid Wisdom Tooth Extraction
For this article to have any real meaning, you’ll need to grasp what’s being discussed fully.
Starting with Medicaid, this is primarily the health insurance with uniform rules nationwide. Both the federal and state governments fund it.
However, the extent of dental coverage or insurance isn’t uniform. In other words, this will vary across states.
With such reality, it’s only logical that we explore the full extent of Medicaid regarding its coverage for dental procedures like wisdom teeth removal. This takes us to the next section.
What Dental Procedures Will Medicaid Cover?
When it comes to oral health, it involves a whole range of services.
These may range from maintenance to restorative services, etc. Due to various factors, Medicaid may not include all dental procedures. While that is true, services covered include preventive care include the following:
Under preventive care, basic procedures include dental sealants, regular checkups, X-rays, dental cleanings, and fluoride treatments.
For periodontal procedures, services include gingivectomy, scaling & root planing, periodontal maintenance, and gum disease treatments.
Oral surgery services provided by Medicaid may include surgical tooth extractions, wisdom teeth removal, and biopsies. Under restorative services, benefits may include extractions, dentures, fillings, crowns, root canals, bridges, etc.
Is Wisdom Teeth Removal Covered Under Medicaid?
The best answer to this question is; it depends on which state you live. In other words, Medicaid coverage for wisdom teeth removal isn’t uniform across the board.
States have specific requirements for dental procedures like this. It also means some states have provisions for wisdom teeth removal under their Medicaid programs.
According to the Medicaid and CHIP Payment and Access Commission (MACPAC), states with Medicaid covering wisdom teeth removal include Arkansas and California.
Others include Colorado, Connecticut, Delaware, Illinois, Iowa, Massachusetts, Minnesota, Nebraska, and New Jersey.
More states with Medicaid covering wisdom teeth removal include New Mexico, New York, North Carolina, Ohio, and Oregon.
There are still more, like Pennsylvania, Rhode Island, South Carolina, South Dakota, Vermont, Virginia, Washington, Wisconsin, and Wyoming.
Besides Medicaid, Where Else Can I Get Wisdom Teeth Removal for Free?
Although Medicaid is quite famous for oral care services like wisdom teeth removal, it isn’t the only option available. You can explore other options if your state lacks Medicaid coverage for wisdom teeth removal.
With that said, what are these alternatives?
They include community health centers, dental charities & nonprofit organizations, state or county health departments, and dental assistance programs.
You can also get free wisdom teeth removal by exploring dental discount plans and utilizing sliding fee scale clinics.
Free wisdom teeth removal can also be enjoyed from dental outreach programs and dental schools. However, it must be said that not all of these options are entirely free.
While some offer significantly discounted dental services, others are entirely free.
As always, these services always come with specific requirements. Determining whether you qualify for the free dental procedure is your job.
For the most part, a majority of persons, especially low-income individuals, and families, get easy access to free dental procedures.
States with the Most Robust Medicaid Coverage for Wisdom Teeth Removal
While seeking information on Medicaid coverage for wisdom teeth removal, exploring your best option by researching states with the most robust Medicaid coverage for wisdom teeth removal is essential.
While this information might be challenging due to multiple factors, we’ve identified a few of these states.
The states of New York, Oregon, California, Minnesota, and Massachusetts are among our top picks for those with the most robust Medicaid coverage.
While true, it’s subject to change as these states might review their Medicaid policies. Other conditions may also climb up the ranking.
Irrespective of the robustness of these Medicaid programs, it must be said that each has its conditions. This applies to all states providing Medicaid-sponsored wisdom teeth removal.
The requirements may include the medical necessity of the procedure, prior authorization, age limitation, and documentation & referrals.
What more? In-network providers are also likely to play a critical role in determining the extent of Medicaid coverage. With these, it’s clear that there’s no one-size-fits-all scenario.
You’ll need to research to select your options. Also, consulting with your provider will be a great way to start.
Paying Out-of-Pocket for Wisdom Teeth Removal
Not everyone will be covered by Medicaid for wisdom teeth removal.
This reality means you’ll have to seek other alternatives. We’ve identified other free options to explore above. Besides those, you can also decide whether to pay out of pocket for wisdom teeth removal.
This is usually the case when out of a network. Here, it means you will bear 100% expenses of wisdom teeth removal. Now the cost of the procedure will be determined by the type of procedure involved.
There is surgical, non-surgical, and essential wisdom teeth extraction.
When surgical extraction of wisdom teeth is done, it mainly includes the removal of all four wisdom teeth simultaneously. This is primarily the case in young adults.
Because the teeth are being removed below the gum line, it’s likely to cost you an average of $3,120. Expenses include general anesthesia.
For non-surgical wisdom teeth extraction, you’re likely to spend an average of $720. The basic extraction procedure of a single wisdom tooth below the gum line will cost you around $550 per tooth.
It’s important to note that these are average costs and not an exact representation of how much you’d pay out of pocket.
Medicaid covering wisdom teeth removal is mainly dependent on the state you live. As discussed above, we’ve identified conditions providing Medicaid coverage for this dental procedure.
However, further research is essential by inquiring about what applies to your state.