When not covered by insurance, a wisdom tooth extraction can be just as painful to your wallet as it is to your mouth.
Medicaid beneficiaries in some states may be able to find some relief. Below is a look at how Medicaid might cover the cost of a wisdom tooth extraction, depending on the state you live in.
How Medicaid covers wisdom tooth extraction in children
Most people have their wisdom teeth extracted before the age of 21, as the teenage years are when wisdom teeth typically appear. Medicaid dental coverage for those under the age of 21 is separate and different from how Medicaid covers dental care for adults.
Every state Medicaid program is required to provide some basic dental coverage for those under the age of 21.
These standards of care include:
They do not, however, include wisdom tooth extraction.
While no state Medicaid program is required to cover the cost of wisdom tooth extraction, many states go above and beyond the minimum coverage requirements set forth by the federal government. States can offer optional Medicaid benefits, which may include additional dental coverage.
The only way to know for sure whether or not your state Medicaid program will cover the cost of a tooth extraction for a child is to contact your state Medicaid program directly.
How Medicaid covers wisdom teeth extraction in adults
Unlike for children, state Medicaid programs are not federally mandated to provide any dental coverage for adults aged 21 and over. Each state determines if and how it will cover any dental services, and that includes wisdom tooth extractions.
Medicaid coverage of a wisdom tooth extraction in an adult may depend on whether the procedure is determined to be an emergency service or not. A wisdom tooth that is impacted and causing a great deal of pain may be considered an emergency and might be covered if the state Medicaid program covers emergency dental care.
The states that offer only limited dental coverage to adults and are thus less likely to cover a wisdom tooth extraction include:
- Arkansas
- Hawaii
- Indiana
- Kansas
- Kentucky
- Louisiana
- Michigan
- Minnesota
- Mississippi
- Missouri
- Nebraska
- Pennsylvania
- South Carolina
- South Dakota
- Vermont
- Wyoming
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The states that offer a little bit more dental coverage to adults and may be more likely to cover a wisdom tooth extraction include:
- California
- Colorado
- Connecticut
- Disrict of Columbia
- Idaho
- Illinois
- Iowa
- Massachusetts
- Montana
- New Jersey
- New Mexico
- North Carolina
- North Dakota
- Ohio
- Oregon
- Rhode Island
- Washington
- Wisconsin
The states that offer “emergency-only” dental care coverage to adults and are likely to only cover a wisdom tooth extraction in an emergency include:
- Alaska
- Arizona
- Florida
- Georgia
- Maine
- Nevada
- New Hampshire
- Oklahoma
- Texas
- Utah
- Virginia
- West Virginia
Only four state Medicaid programs, Alabama, Delaware, Maryland and Tennessee, do not offer any dental coverage for adults.
How Medicaid and Medicare may cover wisdom tooth extractions
Medicaid beneficiaries who are also eligible for Medicare may be able to obtain coverage for a wisdom tooth extraction through their Medicare benefits.
While Original Medicare does not include dental benefits, Medicare Advantage plans may provide benefits not found in Original Medicare. One particular type of Medicare Advantage plan is called a Dual-eligible Special Needs Plan (D-SNP). These plans are specifically designed for people on both Medicaid and Medicare.
Connect with a licensed insurance agent to learn about any D-SNPs available where you live.
Compare plans today.
Speak with a licensed insurance agent