Finding dental insurance can be difficult when you have a low-income, especially when you are older, and eligibility becomes harder to find. Most dental plans are designed to help children as they grow into their new teeth. From 2013 to 2022, the number of Medicaid enrollees increased from 4.5 to 5.2 million. As they grow into adulthood, coverage becomes more difficult to find and more costly. This doesn’t mean that it doesn’t exist. Apart from having a dental plan from an employer, finding a Medicaid dental plan that is best in Texas will be your best choice. And that is what we are here to help you find.
Who is Covered Under Medicaid Dental Plans in Texas?
This can get tricky. Under a medical Medicaid plan, the enrollee’s age doesn’t matter. Now when you begin to talk about dental, as we will discover, age becomes a factor. All health insurance plans in Texas will cover emergency dental procedures. So, if you as an adult are mountain biking and have an accident, your health insurance should cover your broken tooth. However, if you were to have a Medicaid plan and require routine dental care, like a toothache, you may find it a bit more difficult to find coverage because Medicaid only covers from age six months up to 20 years old.
What is Covered Under a Medicaid Dental Plan in Texas?
Most dental plans for children under Medicaid provide minimal services. These are referred to as the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. This benefit must include these services:
- Pain and infection relief
- Restoration of teeth
- Dental health maintenance
A patient must be first seen by their primary care doctor, then referred to a dentist, and finally deemed medically necessary to be covered. There are also periodic schedules that need to be followed in between procedures. Consult with your dentist to determine these time periods. The overall schedule will be determined by the dental organization.
Medicaid Dental Insurance Plans Offered in Texas
One thing common to all three of these Medicaid dental plans is a program called Texas Healthy Steps. This program keeps track of a child’s dental health and sends reminders when a check-up is needed. Not only is your dentist involved in this program, but your primary care provider takes part as well. It can assist you with diagnosing dental issues and recommending treatment that they may notice since you see them more often. This program is part of your dental care and not an added feature, and your dentist will automatically keep an eye on your child to know what to expect.
DataQuest
This plan is the most popular of our bunch, providing dental services from six months to twenty years old. They do not offer adult coverage. While most of our other options offer Texas Health Steps as an added option to their services, for DataQuest, TH Steps is the plan. TH Steps is a Medicaid services program that gives free dental checkups beginning at six months. This service partners with DentaQuest to provide dental services to your child like:
- Exam, cleaning, and fluoride treatment every six months
- X-rays every six months
- Restorative and Endodontic services, Oral surgery, and other medically necessary treatments.
Services not covered: - Services that are not medically necessary for dental health
- Cosmetic dental care
- Experimental procedures
- If another insurance or health plan covers your service, DentaQuest will seek reimbursement.
Other services covered:
- Nonemergency Medical Treatment Services (NEMT) – Transportation service for non-emergency medical for those who would not have any other options available to them. This service will cover the cost of travel and many expenses such as lodging and a meal expense for you and a companion. This is a great benefit for low-income families who need the benefit of getting to some appointments.
Emergency Dental Care: in the event of an dental emergency: Contact your dental provider. If it is after hours, you can contact your main medical provider or contact Medicaid for instructions.
MCNA Dental (Managed Care for North America) Dental
MCNA has a more extensive Medicaid Dental plan in Texas than DentaQuest, with no out-of-pocket charges for their covered care. The ages remain the same, covering 6 months up to 20 years with no adult coverage.
Coverage for services is 100% unless you are also receive CHIP. Then you may have a copay for certain services. This will vary depending on the family’s income.
MCNA has an extensive list of benefits:
- Dental office visits
- Oral exams
- X rays
- Oral Surgery – Extractions
- Restorative services – Fillings and crowns
- Endodontic Services – Root canals
- Periodontal – Dentures
- Orthodontic Services – Braces
- Prosthodontic Services – Crowns Inlays
- Sedation and Hospitalization if needed
- Texas Health Steps
Dental services that are not covered are:
- Dental procedures that are not medically necessary
- Cosmetic dental care
- Prescription Drugs (this benefit is covered in most over plans)
- Procedures that would be covered under a medical insurance plan
Emergency dental care: Your child can be seen by a doctor in a hospital or urgent care facility. Payment will be made for dental care through Medicaid in these instances:
- Dislocated jaw
- Traumatic injury to teeth or supporting jaw structure
- Cyst removal
- Oral abscess of tooth or gum origin
United Healthcare
Unlike MCNA, United Healthcare’s Medicaid Dental Plan in Texas is not as extensive in available options. However, like all three options, it is available from 6 months up to 20 years with no adult coverage. Covered benefits include:
- Exam, cleaning, and fluoride treatment every six (6) months
- X-rays every six (6) months
- Fillings, extractions, crowns, root canals, and other medically necessary treatments
- Includes prescriptions
- Emergency medical services when out of town
- Texas Health Steps
Dental services that are excluded from coverage:
- Cosmetic dental care
- Any procedure that could be deemed experimental
- Services that are not considered medically necessary
- Services that are covered under another medical plan
Emergency dental care: If your child needs emergency dental care, you don’t always have to be seen by a dentist. Certain dental care can be covered by your main Medicaid medical provider. These instances can include:
- Dislocated jaw
- Traumatic injury to teeth or supporting jaw structure
- Cyst removal
- Oral abscess of tooth or gum origin
Medicaid Dental Plan Review
As you can see, most plans have the same type of benefits, covering only children up to the age of 20, but each will have its own tweak in how that coverage is dispensed. Through the services offered, we can see that MCNA offers the best Medicaid dental coverage in low-income family Texas. Their only downfall is their lack of a prescription drug offering.
DentaQuest offers an excellent dental service by providing away-from-home dental treatment through NEMT (Non-Emergency Medical Treatment). If you require extensive work on your teeth and believe you need a specialist to perform this work, this would be a better plan for you.
