When asking whether Pregnancy Medicaid covers dental or vision services, you must consider the type of coverage you have and the rules in your residence state.
Women under twenty-one qualify for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), which includes comprehensive oral and vision care.
Women whose household income qualifies them for full-scope coverage have the same dental and vision benefits as other adults in their state.
Women over twenty-one eligible for limited coverage have dental benefits for conditions that might complicate the pregnancy or harm their unborn baby.
In other words, contact the Managed Care Organization (MCO) administering your plan as this organization decides whether to honor specific claims.
Pregnancy Medicaid Dental
Your MCO determines when Medicaid covers dental work for pregnant women for each plan type. Each pathway employs different criteria for supporting oral health claims as each state decides.
Dental Implants
Pregnancy Medicaid probably will not cover dental implants or the other two pathways, as this expensive tooth replacement procedure is deemed cosmetic in most cases.
Only one state (NY) covers dental implants through Medicaid unless the procedure is medically necessary: it treats an illness, injury, or symptoms. However, the instances where the health insurance component kicks in are infrequent, especially with pregnant women.
- Prevent further bone atrophy caused by diseases such as diabetes, digestive disorders, or osteoporosis.
- Strengthen the jaw bone after accidental fractures or surgery to remove cancerous lesions.
Removable Dentures
Pregnancy Medicaid, and the other two pathways, is more likely to cover removable dentures as this dental service represents the least expensive treatment alternative for missing teeth.
Medicaid covers adult dentures through the full-scope plan in thirty-three states and the children’s version nationwide.
However, proving that missing teeth pose a risk to your unborn baby might be challenging. Plus, pregnancy-related gingivitis frequently occurs, making it a poor time to get dentures.
Periodontal Treatment
Pregnancy Medicaid will most likely cover periodontal treatment as gingivitis is a common disorder for pregnant women. Hormonal changes while carrying a baby can make your gums more vulnerable to plaque, leading to inflammation, bleeding, and infection.
Gum disease treatment costs are more manageable when Medicaid covers the services. However, the three plan types work differently.
- Limited plans might pay for periodontal treatment when infection poses risks to the unborn baby.
- Full-scope coverage addresses periodontal differently in each state, with nineteen paying for adult services.
- EPSDT plans probably include this benefit for teenage women carrying a child.
Wisdom Teeth
Many pregnant women can get their Medicaid plan to pay for wisdom teeth extractions, although coverage for this dental procedure hinges on whether the third molars are bone-impacted.
Full-scope Medicaid for adults covers wisdom tooth removal uniformly nationwide when bone-impacted, as this procedure is medically necessary and addressed under the health insurance component. However, only twenty-one states offer benefits for oral surgery for gum-impacted third molars.
- EPSDT plans probably cover wisdom teeth extraction for bone and gum-impacted third molars.
- Limited plans are more likely to cover bone-impacted extractions as the inherent infections can spread, risking the health of unborn babies.
Root Canal
Many pregnant women can get their Medicaid plan to cover root canals and the removal of infected pulp from inside the tooth by an endodontist. However, some living in specific states cannot.
If you can’t afford a root canal, a payment plan might help women on full-scope pathways in the sixteen states without restorative dental benefits for adults over twenty-one.
- Limited plans might pay for root canals, as pulp infections can spread throughout the body and threaten babies’ health.
- EPSDT plans probably include root canal benefits for teenage women carrying a child.
Dental Braces
Medicaid coverage for dental braces depends on the pregnant woman’s age, state, pathway, and treatment choice. Straightening crooked teeth can take years, while normal gestation ends after only nine months—a key consideration for those with temporary benefits.
Medicaid rarely covers Invisalign, as the clear plastic trays are not the least costly treatment alternative for crooked teeth. Metal braces, subject to pathway-based limitations, fit this coverage rule.
- EPSDT plans probably include this benefit for teenage women carrying a child.
- Limited coverage is likely unavailable because malocclusions do not pose risks to unborn babies.
- Full-scope plans might cover braces for adults over twenty-one for medically necessary reasons.
- Reposition teeth after a non-biting accident such as a broken jaw
- Temporomandibular Joint Disorders (TMJ or TMD) bite adjustments
- Sleep apnea (when crooked teeth restrict or block airflow)
Pregnancy Medicaid Vision
Pregnant women are less likely to get Medicaid to cover vision services because only one and a half of the pathways will honor claims to correct refractive errors (exams, glasses, contacts). Meanwhile, the rules for eye surgeries are murky.
- EPSDT plans probably include vision benefits for teenage women carrying a child.
- Limited coverage is likely unavailable as poor eyesight poses no health risk to unborn babies.
- Full-scope plans pay for vision care following the rules adopted for adults by each state.
Optometry
Pregnant women are least likely to get Medicaid to cover vision services provided by an optometrist specializing in correcting refractive errors. An optometrist conducts eye exams and prescribes eyeglasses and contact lenses to improve visual acuity.
Full-scope Medicaid covers eyeglasses and contacts for adults in thirty-eight states, while twelve have no benefits. However, expectant women on the limited plan might have difficulty proving that blurry vision poses a health risk to their unborn baby.
Ophthalmology
Pregnant women are more likely to get Medicaid to cover vision services provided by an ophthalmologist specializing in diagnosing and treating eye diseases because the program’s healthcare component pays for these services.
Full-scope Medicaid pays for many eye surgeries nationwide when medically necessary (including EPSDT plans) when acting as health insurance. However, the limited plan is less likely to honor claims because many underlying conditions do not pose a health risk to unborn babies.
- Strabismus (lazy eye)
- Cataract (cloudy lenses)
- Glaucoma (high eye pressure)
However, the limited plans might cover eye surgeries performed by ophthalmologists when the condition poses risks of pregnancy complications. For instance, an Ocular Nevis involves cancerous cells that can spread throughout the body.
