Dental Office That Accepts Medicaid Insurance

Understanding Medicaid Insurance

Medicaid is a federal and state program that provides healthcare coverage to qualified lower-income families and individuals.

Medicaid programs are state run; therefore, each state have their own programs and can decide which medical service to provide however, the federal government has rules and regulations under which all states must comply as, the federal government provides at least 50% of the funding of the Medicaid programs.

Individuals who qualify for Medicaid typically don’t have to pay for monthly premiums unless, it is required by their state, most of the health services are generally free.

Typically, a state may create and run their own Medicaid programs in the best interest of the people and may choose to provide more services than the federal government may require.

Individuals and families who qualify for Medicaid are approved based on their income and assets.

Who Qualifies for Medicaid

The following groups of people are eligible for Medicaid coverage

  • Pregnant women with low income
  • Seniors with low income
  • Children of low-income families
  • Children in foster care
  • Parents or caregivers with low income
  • People with disabilities

A state may choose to expand eligibility to additional groups.

To qualify for Medicaid, an individual’s income must fall below the FEDERAL POVERTY LEVEL (FPL). The FPL accounts for minimum amount of gross income that a family needs for food, clothing, transportation, shelter and other necessities.

Under Indiana’s Medicaid eligibility guidelines several individuals are eligible for Medicaid services up to the following amounts

  • 208% of the FDL for children up to 1 year of age.
  • 158% of FPL for children 1 to 18 yrs old.
  • 208% of FPL for pregnant women and this continues for the baby till they are 12 months of age.
  • 138% of FPL for other adults under the age of 65 yrs.

Benefits of Medicaid for Dental Care

Every state differs in the dental services that they provide under Medicaid coverage. While it covers most of the health services, the coverage of dental services are optional. Medicaid in some states provide a comprehensive dental coverage including preventive, diagnostic and treatment services, while other states may have a more limiter or absolutely no dental coverage.

Dental benefits of children in Medicaid

Medicaid covers dental services for all children in the EARLY AND PERIODIC SCREENING, DIAGNOSTIC and TREATMENT(EPSTD) BENEFIT. Though oral screening is a part of the physical examination, it does not replace the need for a physical examination by the dentist. The dental services must minimally include

  • Relief of infections and pain
  • Restoration of teeth
  • Maintenance of dental health

EPSTD benefit requires that all services must be provided if medically necessary. If a condition requiring treatment is found, then the state must provide the services necessary to treat the condition whether or not its included in the Medicaid plan.

Dental benefits of children in CHIP

The Children’s Health Insurance Program (CHIP) are required to cover dental services ‘necessary to prevent diseases and promote oral health, restore oral structures to health and function’. The CHIP falls under Hoosier Healthwise Program. CHIP is for children upto the age of 19 yrs coming from families with slightly higher income.

States that provide CHIP services to children are required to provide EPSTD benefits also.

CHIP requires a low monthly premium for coverage and also a copay for some services.

Hoosier Healthwise has two packages to choose from

PACKAGE A – This is a full-service plan for children and pregnant women.

PACKAGE C – This is a full-service plan for children that are enrolled in CHIP. This plan requires a monthly premium and a co-pay for some services.

The state is also required to post a listing of all participating Medicaid and CHIP dental providers on InsureKidsNow.gov.

When enrolling in Hoosier Healthwise, an individual may choose among the following

  • Anthem
  • CareSource
  • Managed Health Services
  • MDwise

Dental Benefits for Adults

The state has flexibility to decide what dental benefits are to be provided to adults under Medicaid. There is minimum requirement for adult dental coverage.

For adults’ annual exams and preventive care are covered. An individual may still be required to pay a co-pay cost for their dental visit.

For general description of benefits and services please refer to Indiana Medicaid Covered Services Page

Is Your Dentist a Medicaid Provider?

Use the IHCP Provider Locator to determine if your dentist is a Medicaid provider. It is important to know if the dental office you are visiting accepts Medicaid as your treatment will not be reimbursed if the dental provider is not enrolled in Medicaid.

What to Expect During Your Visit.

Patients with Medicaid should call to see we are the right fit for you. When you check-in, we gather insurance information that will be required to know if your primary concern qualifies under Medicaid services offered. All you have to do is provide us with your Medicaid Enrollment Information, let us take care care of submitting your claim to Medicaid.

We believe in transparency hence, we let you exactly which treatments will be covered under your Medicaid insurance.

. We offer you with the advantage of flexible scheduling, so you decide what time works best for you and your family.

. We accept many payment options- from Medicaid and payment plans for insurances.

Benefits for Choosing Sky View a Medicaid dental office

At Sky View we care about every patient that walks into our door. We are determined to make sure that we meet all the dental needs of all our patients. We are listed as a registered Medicaid dental care provider in Indiana and are happy to accept patients from all backgrounds including the lower income families across Indiana.

We provide dental services to majority of our patients who are on Medicaid insurance as well as most dental plans to make dental care easily accessible. We guarantee you access to quality dental care for you and your family. Call us today (317) 886-9500 to schedule your appointment at the Medicaid dentist near you.