Medicaid in Colorado : Frequently Asked Questions

Medicaid in Colorado: Frequently Asked Questions

Medicaid dental benefits in Colorado are administered by Health First Colorado. Dental benefits are available to Colorado residents who may meet specific monthly income requirements. Medicaid in Colorado provides an avenue for families in our community to access free or low cost dental care. Medical benefits are also available. Here are some frequently asked questions about Medicaid dental benefits.

Medicaid in Colorado

How does medicaid in Colorado work?

To access medicaid dental benefits in Colorado, an application can be fill out at the Health First Colorado website or at a local office. The application will be reviewed to determine if you can qualify for medicaid dental benefits. Once approved for benefits, a member identification number will be issued much like a private insurance plans. Provider locations and contact info can be accessed through the Health First Colorado website or through common search engines.

How do I find medicaid dentists in Colorado?

Before you can schedule a dentist appointment, you need to find a provider that will accept Colorado medicaid benefits. To find a dentist that accepts Medicaid, DentalScout offers an easy way to find high quality dentists that take medicaid and are currently accepting patients. Find one near you, Dentists that accept medicaid!

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What dental treatments does medicaid cover?

Medicaid coverage varies from state to state, but in most states basic preventive dental services are covered. These services include x-rays, exams, cleanings, fillings, and extractions. Many states also offer orthodontic care and denture coverage as well. Restorative (crowns and bridges) and cosmetic services are not covered by Medicaid except in rare circumstances.

How much does dental care cost under medicaid?

Dental costs for treatment for medicaid will vary depending on geographic location. For instance, Denver generally has higher dental costs than the rural areas of Colorado. Patients using medicaid dental benefits can expect to pay no more than $27 for a general dentist visit and no more than $11 for cleanings. For non-emergent care, patients will be responsible for their portion of the cost directly to the dental office before services are rendered. Patients who choose to use Medicaid dental benefits should always ask prior to receiving any treatment how much their out of pocket cost will be.

Medicaid for children

For Children: Colorado Medicaid provides benefits for adults and children. For children under the age of 21, full range of dental treatment is covered. Dental treatments include: x-rays, periodic and emergency exams, dental cleanings, fillings, crowns and root canals, and tooth extractions. Even limited orthodontic treatment, (for example: braces), may be covered. Additionally, for children under 21 there is no benefit maximum. This means that even in a situation where a child may need extensive dental treatment the out of pocket cost a parent will incur will likely be minimal if any at all.

Medicaid for adults

For Adults: Medicaid covers a significant range of dental treatments and also offers a healthy yearly benefit of $1,500 at this time. There is no orthodontic coverage for adults aged 21 and older. X-rays, exams, cleanings, fillings, root canals and crowns, tooth extractions, and removable appliances such as dentures and partials are covered.

In cases where extensive dental treatment is needed that would exhaust the $1,500 benefit maximum, any needed treatment would require out of pocket payment. However, out of pocket costs incurred after the yearly benefit is exhausted is still available at a significantly reduced price, often 50-70% percent lower than what that same treatment may be at full price. Overall, participation in Medicaid for adults can allow access to dental care at no cost and even for extensive treatment for pennies on the dollar. 

Does medicaid cover emergency dental procedures?

Medicaid does cover emergency dental procedures for both adults and children. The most common emergency dental procedures are: dental x-rays, emergency exams, tooth extractions, pulpectomies, root canals and crowns, and fillings. If multiple extractions are needed, a referral can be made to an oral surgeon for the extractions with the aid of sedation. When sedation is available it can provide a much needed solution to the dental anxiety associated with multiple extractions. (It is important to not that that sedation may only be covered when there is a need for multiple extractions. Sedation is not usually covered by insurance or generally provided by general dentists.) 

What to expect for your first dental appointment using medicaid?

Fortunately, Medicaid is only a benefit plan and therefore does not limit the level of proper dental care that a patient can and should receive. A first dental visit will be much the same as a dental visit using a private dental insurance or just paying cash. First, a comprehensive medical history and interview will be conducted and then any primary dental concerns will be discussed. Based on your concerns, x-rays will be taken and an exam will be performed to identify the presence of any cavities, broken or fractured teeth, tooth infections, and gum infection or disease. Based on any findings discovered, your dentist will review any options or treatments available to you. At that point, benefits from Medicaid can be applied as available if you choose to pursue any needed dental treatment. 

Why don’t all dentists take Medicaid?

There are several distinct kinds of dental clinics and numerous sorts of insurance coverages, as well as various dental practice demands based on the region a dentist serves. Therefore, there may not be a need for a dental office to accept Medicaid dental benefits depending on the geographical location.

Also, while the privilege to provide dental care to low or no income communities is immense, the administrative costs and complexity for a dentist to participate with Medicaid is many times greater than the cost to participate with private insurance companies. While most small businesses would want to join with Colorado Medicaid dental plans, they lack the administrative capacity to do so.

Medicaid dental benefits in Colorado provide a great opportunity to maintain good oral health. Dental care is comprehensive, and the Medicaid benefit level is sufficient to cover the majority of dental expenditures. For further information and guidance on Medicaid in Colorado, go to the Health First Colorado website.

Related Articles:

5 Ways to calm your anxiety about going to the dentist
First Visit to a Dentist: What to Expect for Your Appointment
Why Visiting the Dentist with No Insurance is Better

Medicaid Dentist

Written by: R. Asher Henegar, D.D.S., P.A.

General Dentist - Accepting Medicaid

DentalScout

Curator: The DentalScout Team

25+ Years of dental experience

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