Keeping up on oral care is a critical piece of maintaining your overall health. It is advised to visit the dentist twice a year for a checkup to ensure your teeth are healthy and clean and that you don’t have any cavities, tooth decay, or other oral health issues, including gum disease, cancer, and more. While highly important, dental care can be quite costly, and many people carry dental insurance to help cover the bills. Medicaid is a common health insurance used by millions of people across the United States. Depending on your residency status in North Carolina and the dental care you require, Medicaid services may provide coverage for your dental needs.

What Type of Dental Care is Commonly Provided?

Dental needs can vary widely from person to person. One of the most common procedures done is a routine cleaning. This involves removing the plaque and tartar that builds up on, around, and between the teeth and gums. These cleanings can also help to remove any stains that have become apparent on the teeth and create a protective coating on the teeth to better shield them from damage by bacteria.

During these cleanings, the dentist or dental hygienist also looks for any cavities or tooth decay that have occurred. If they are significant enough, your teeth may require fillings and repairs to remove the rotted portion of the tooth and replace it with metal or glass to prevent further damage. If cavities are not attended to quickly, they can cause severe tooth rot and may require tooth extraction.

Some other common dental procedures include root canals, which involve removing and replacing the center core of the tooth; sealing the surface of the teeth to create a barrier to bacteria; teeth whitening procedures; fittings for dentures, which can include just a few fake teeth or serve as a full new set; and more.

What Do Medicaid Services Cover in North Carolina?

Medicaid is primarily designed to cover individuals with low income levels, making high copayments or out-of-pockets even more difficult to cover. Luckily, for residents of North Carolina, Medicaid insurance can help cover some dental needs. Across the country, Medicaid provides more services for children than adults. No matter where you live, all children covered by Medicaid must have access to care to maintain their dental health, relieve any pain or infections, and restore damaged teeth.

Outside of these minimal requirements, each state determines their own specific regulations regarding dental services that are covered by this insurance plan. North Carolina is one of 17 states that offers “extensive” dental benefits. This category covers the widest range of dental care. Some of the procedures and services offered to Medicaid recipients in North Carolina include routine examinations, preventative services, basic and advanced tooth restoration, periodontal services, denture fitting and placement, and oral surgery.

Dental care that is deemed “medically necessary” is covered by Medicaid. This includes routine checkups for both adults and children. However, care that is deemed “experimental” is not covered by this policy. Full x-rays are covered once every five years, complete denture replacement is covered every 10 years, and partial denture replacement is covered every 8 years. North Carolina also does not place a limit on the total amount of dental care one individual can receive on an annual basis.

Another important thing to consider is if you qualify for dual-eligible coverage, meaning that you are able to receive care from both Medicare and Medicaid. Dual-eligible healthcare plans are available to some individuals over the age of 65, or under 65 with certain disabilities, with low income levels. Medicaid may be able to help cover some of the copayments, annual premiums, and other expenses that you may have from Medicare.

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