A seemingly simple question, “Does Medicaid cover dentures for adults?” can have a complicated answer.
First, the state where you live matters, as thirty-four support claims for false teeth, while sixteen do not.
Second, the thirty-four states have different underwriting rules for snap-in, same-day, partial and complete dentures.
Third, each state has differing standards for how often they pay for repairs, adjustments, relining, and replacements.
Finally, the retail price of your dentures minus the annual maximum benefit in your plan determines how much they cost out-of-pocket and if you can afford them.
Medicaid Denture Coverage By State
First, we must establish whether Medicaid covers dentures for adults in the state where you live and your plan. We are not the ultimate authority, but the entity that processes your claims is, and you will learn how to contact them.
Low-income adults receive free dentures when their state supports restorative benefits, and they choose the least costly treatment alternative to replace missing teeth.
Benefits By State
A listing of states provides a preliminary answer as to whether your specific Medicaid covers dentures in your residence state. Our research indicates that thirty-four states support prosthodontics, while sixteen do not.
Follow the links to find information published for the general public.
34 States Covering Dentures
| Alaska | Alabama | California |
| Colorado | Connecticut | Delaware |
| Florida | Hawaii | Iowa |
| Idaho | Illinois | Indiana |
| Louisiana | Massachusetts | Michigan |
| Minnesota | Montana | North Carolina |
| Nevada | New York | Ohio |
| North Dakota | Nebraska | New Jersey |
| Oregon | Pennsylvania | Rhode Island |
| South Dakota | Utah | Virginia |
| Vermont | Washington | Wisconsin |
| Wyoming |
16 States Not Covering Dentures
| Arkansas | Arizona | Georgia |
| Kansas | Kentucky | Maryland |
| Maine | Missouri | Mississippi |
| New Hampshire | New Mexico | Oklahoma |
| South Carolina | Tennessee | Texas |
| West Virginia |
Coverage by Plan
Even in states supporting prosthodontic care, you may encounter different rules regarding whether Medicaid covers dentures for every plan. Recipients often enroll in sub-programs with unique benefits.
- Emergency Medicaid for undocumented immigrants
- Pregnancy Medicaid for women expecting a baby
- Straight Medicaid: a fee for service arrangement
- Regular Medicaid: run by a Managed Care Organization (MCO)
Claims Administrators
The organization administering claims for your specific Medicaid plan provides the most reliable and comprehensive information about whether it covers dentures.
Your state might administer claims for all recipients. More frequently, they outsource the function to private third-party companies.
- Managed Care Organization (MCO primarily medical claims)
- Dental Benefits Manager (DBM exclusively oral care claims)
Managed Care Organizations
Your MCO might be the final authority on whether your adult Medicaid plan covers dentures. You should be able to find their name and logo printed on your membership ID card.
Some more prominent MCOs include Wellcare, CareSource, Molina, HIP, Healthfirst, Aetna Better Health, and many others.
You might find reliable, comprehensive information from your MCO if they process dental claims themselves. If so, gather other relevant details to help you answer essential questions.
- How often does it pay for new appliances?
- Cost-sharing features: deductible, coinsurance, or copayments
- The annual maximum benefit amount
Dental Benefits Managers
Your DBM frequently provides the most reliable and comprehensive information about your adult Medicaid plan’s denture coverage because it is their specialty.
You might find the DBM assigned to your plan through your state or MCO. Many outsource the processing of dental claims to these experts.
Medicaid Denture Coverage Types
Next, we need to cover whether Medicaid covers the specific type of denture a given recipient might desire, assuming their state supports claims for false teeth.
The price points and rules vary for Snap-in, permanent, same-day, complete, and partial appliances.
Snap-In Dentures
It is unlikely that Medicaid covers Snap-In dentures for adults, regardless of their support for prosthodontic benefits. Snap-in or permanent crowns are the finishing touches that a dentist adds to dental implants.
Only the NY Medicaid program covers tooth implants, which other states deem cosmetic. A lower-cost viable treatment alternative exists (removable appliances). However, recipients with medically necessary reasons might get lucky.
Same-Day Dentures
Medicaid is less likely to cover same-day dentures in any state supporting prosthodontics because immediate false teeth add to expenses.
With same-day dentures, the prosthodontist fabricates temporary replacement teeth in the office after extracting your existing molars, incisors, or bicuspids. The extra step increases the price.
The least expensive alternative treatment clause built into this taxpayer-funded insurance program for low-income adults means that the MCO or DBM might deny claims for same-day dentures unless explicitly permitted.
However, every rule has exceptions, as at least Nebraska and North Dakota explicitly state they cover immediate dentures. Contact your MCO or DBM to verify.
Full Dentures
Medicaid is likely to pay for complete dentures for adults in the states that support prosthodontics, with one significant caveat: the annual maximum benefit limit payments.
The price of full dentures with extractions with insurance is higher because the lab must fabricate an appliance with a complete set of replacement teeth: sixteen for uppers and sixteen for lowers.
Complete dentures cost up to $3,000 per arch ($6,000 full-mouth), meaning an annual maximum benefit of $1,500 could leave you with a significant balance due after treatment.
Partial Dentures
In thirty-four states, Medicaid will likely pay for partial dentures for adults supporting prosthodontic benefits. Plus, the annual maximum benefit has less bite because of the lower price.
A partial denture is a plate with one or more false teeth made of plastic or metal with clasps to keep the appliance in your mouth.
Partial denture costs of $500 to $1,500 might squeeze under your plan’s yearly limit, possibly leaving you with no balance due.
Medicaid Denture Coverage Frequency
Once you establish whether your state supports benefits for false teeth, you may want to know how often your Medicaid plan will pay for dentures. As you will see, the frequency is all over the map.
More Often
Medicaid will pay for dentures more often when the patient needs less costly repairs, adjustments, and relines of existing appliances. Your DBM or MCO is the final authority, but we found several examples illustrating the higher frequency associated with less expensive services.
- Delaware: reline dentures once every two years
- Connecticut: repair or modification once every two years
- Nevada: six relines per rolling sixty months
- North Dakota: adjustments twice per year, relining once annually
Less Often
Medicaid will pay for replacement dentures less often when the recipient needs a brand new set of false teeth because this service costs much more. Each state supporting prosthodontics makes different rules regarding service frequency.
Your DBM or MCO is your final authority. Below is the available information illustrating the state-by-state variations.
| Frequency | States |
|---|---|
| Once every 6 years | Louisiana, Michigan, Montana (partials), South Dakota |
| Once every 7 years | Minnesota |
| Once every 10 years | Idaho, Connecticut, North Dakota |
| Minimum of 8 years | New York |
| Once per 10 years | Montana (full) |
| When medically necessary | Ohio |
| Once per lifetime | Pennsylvania |
Medicaid Denture Costs
Finally, adults must know how much dentures cost with Medicaid, assuming their state supports prosthodontic benefits.
Recipients over 21 can project their spending by factoring in their annual maximum benefit and the price and quality of the appliance.
Annual Maximum
The annual benefit maximum is enormous when determining how much your dentures will cost with Medicaid. Many states impose a yearly limit on what your plan might pay towards covered dental services.
Contact your MCO or DBM before starting treatment to verify your maximum annual benefit. Only a handful of states make this information publicly available.
- Alaska: $1,150
- Arkansas $500
- California: $1,800
- Connecticut: $1,000
- Iowa: $1,000
- Montana: $1,125
- South Dakota: $1,000
If you max out your annual benefit, spread the treatment out over two or more years.
- Year 1: Extractions
- Year 2: Upper jaw
- Year 3: Lower jaw
Appliance Prices
The retail price affects how much your dentures will cost with Medicaid because the annual maximum benefit weighs so heavily. Most charges will be well above what the state pays toward treatment.
Free dentures through Medicaid may not look the greatest because you might have to choose the lowest-quality appliances. However, even a plastic smile beats a mouth of missing teeth.
Subtract the annual benefit maximum from the price to estimate your out-of-pocket costs to see if you can afford a new set of choppers.
Partial Denture Cost
| $700 * | $1,000 * | $1,600 * | |
| $500 ** | $200 | $500 | $1,100 |
| $1,000 ** | $0 | $0 | $600 |
| $1,500 ** | $0 | $0 | $100 |
* Retail price
** Annual Maximum Benefit
Full Denture Costs
| $1,000 * | $3,000 * | $6,000 * | |
| $500 ** | $500 | $2,500 | $5,500 |
| $1,000 ** | $0 | $2,000 | $5,000 |
| $1,500 ** | $0 | $1,500 | $4,500 |
* Retail price
** Annual Maximum Benefit
