Yes, Medicaid will cover bony wisdom teeth impaction, or cases in which the wisdom teeth are fully erupted through the gums, but other coverage depends on where you live. Medicaid covers bony wisdom teeth impaction in all states as a medically necessary procedure, since this event is considered an emergency that can cause pain and lead to infection if left untreated.
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Understanding Wisdom Tooth Extraction
Since wisdom teeth are the last of the permanent teeth to erupt, many people do not have room left for their wisdom teeth to push through the gums without pain or discomfort. Leaving your wisdom teeth to erupt on their own can cause the teeth to erupt improperly. This could crowd your existing teeth, cause infections, or the teeth could get trapped under the gums.
While dentists may subscribe to different theories about wisdom tooth extractions, many dental professionals and orthodontists recommend removal of the wisdom teeth as a preventive measure. Undergoing wisdom teeth removal as a minor covered by Medicaid and the Children’s Health Insurance Program (CHIP) can prevent later complications.
How Does Medicaid Cover Wisdom Teeth Removal?
Medicaid only covers certain types of wisdom teeth removal and leaves decisions about coverage for other routine dental services up to individual states.
Eligibility
All children with CHIP are eligible for wisdom teeth removal as a preventative procedure. Adults seeking wisdom tooth extractions on Medicaid must be experiencing an emergency bony wisdom tooth impaction or, in rare cases, their state may offer non-emergency dental benefits as a preventive measure.
General eligibility for Medicaid in any state is primarily dependent on income. Eligible beneficiaries cannot earn more than the maximum income, either individually or as part of a household, in their state. Other factors affecting eligibility include being pregnant, caring for a minor, being disabled, or being older than age 65.
Types of Wisdom Teeth Removal
States may offer Medicaid coverage for wisdom teeth removal depending on whether your wisdom teeth are fully or partially erupted through your gums.
Bony Wisdom Teeth Impaction
Bony wisdom teeth impaction occurs when your wisdom teeth have fully erupted through your gums. Full eruption of the wisdom teeth commonly causes pain at and around the site of the eruption and can lead to permanent shifting of the surrounding teeth and infections of the teeth and gums.
Dentists consider bony wisdom teeth impaction a dental emergency that typically requires immediate wisdom teeth removal out of medical necessity. Medicaid covers bony wisdom teeth removal for adults in all states, as it is part of Medicaid’s minimum dental benefits requirements.
Soft Tissue Wisdom Teeth Impaction
Soft tissue wisdom teeth impaction occurs when the wisdom teeth have not fully erupted through the gums. This event is not widely considered a dental emergency. Since extraction is not always considered medically necessary in this case, Medicaid in many states does not cover soft tissue wisdom teeth impaction.
State | Medicaid covers soft tissue wisdom teeth impaction |
|---|---|
Alabama | No |
Alaska | No |
Arizona | No |
Arkansas | Yes |
California | Yes |
Colorado | Yes |
Connecticut | Yes |
Delaware | Yes |
Florida | No |
Georgia | No |
Hawaii | No |
Idaho | Yes |
Illinois | Yes |
Indiana | No |
Iowa | Yes |
Kansas | No |
Kentucky | No |
Louisiana | No |
Maine | No |
Maryland | No |
Massachusetts | Yes |
Michigan | No |
Minnesota | Yes |
Mississippi | No |
Missouri | No |
Montana | No |
Nebraska | Yes |
Nevada | No |
New Hampshire | No |
New Jersey | Yes |
New Mexico | Yes |
New York | Yes |
North Carolina | Yes |
North Dakota | No |
Ohio | Yes |
Oklahoma | No |
Oregon | Yes |
Pennsylvania | No |
Rhode Island | Yes |
South Carolina | Yes |
South Dakota | Yes |
Tennessee | No |
Texas | No |
Utah | No |
Vermont | Yes |
Virginia | Yes |
Washington | Yes |
West Virginia | No |
Wisconsin | Yes |
Wyoming | Yes |
How Much Does Wisdom Teeth Removal Cost?
The cost of wisdom teeth removal depends on several factors. This includes whether the teeth are fully or partially erupted, and the level of surgical removal required. Since most oral surgeons charge per tooth for extractions, the cost of removing as many as four wisdom teeth at one time can add up.
Of course, dental coverage, or lack thereof, can also contribute to the overall cost. Adults who do not have Medicaid or dental insurance may pay between $100 and $1,000 per tooth for wisdom tooth extractions, depending on whether the tooth is severely impacted or not. The cost of extractions with Medicaid varies by state; Medicaid caps coverage at $500-$1,800 for dental services in many states.
Does Medicaid Cover Other Dental Care?
Medicaid in all states covers dental care for children under the Medicaid and CHIP. This includes preventive services and screenings. At a minimum, states are required to provide relief of pain and infections, restoration of teeth, and maintenance of dental health to children under the age of 18.
Medicaid does not maintain the same minimum dental coverage requirements for adults. States may choose whether to offer routine dental services to adults, as there are currently no minimum dental health requirements. Less than half of all states offer Medicaid-sponsored adult dental health services including non-emergency diagnostics, screenings, and maintenance.
Putting It All Together
Medicaid covers emergency wisdom teeth extractions as a medically necessary procedure, and some states cover non-emergency dental benefits including wisdom teeth removal for adults. All states offer wisdom tooth extractions for children as part of Medicaid and CHIP benefits, enabling minors to undergo preventive wisdom teeth extraction before the teeth fully erupt. States that cover wisdom tooth extractions through Medicaid also cover X-rays, sedation, and medications.