What Does Medicaid Cover for Dental for Adults in Colorado?
Get clear answers on adult dental coverage through Colorado Medicaid, including services and benefit navigation.
Medicaid, known as Health First Colorado, offers healthcare coverage to eligible residents who meet specific criteria. For adults, this coverage extends to dental services designed to promote oral health. This article details the eligibility requirements for adults to receive dental benefits, outlines the specific services covered, and provides guidance on how to navigate these benefits effectively.
Eligibility for Adult Dental Benefits
To qualify for Health First Colorado and its associated dental benefits, adults must meet certain eligibility requirements. Individuals under 65 years old can enroll if their household income is at or below 138% of the Federal Poverty Level (FPL). For example, as of April 1, 2024, a single adult with a monthly income up to $1,735 or a two-person household with a monthly income up to $2,345 would typically meet the income criteria. These income limits are subject to change annually, reflecting adjustments in the cost of living.
Beyond income, applicants must be residents of Colorado and be either U.S. citizens, nationals, permanent residents, or other qualified non-citizens. There is no asset test for income-based Health First Colorado, meaning personal assets do not affect eligibility. The application process can be completed online through the Colorado PEAK website, which is often the fastest method. Alternatively, applications can be submitted in person at a county human services office, by mail, or over the phone.
Covered Dental Services
Health First Colorado provides a broad scope of dental services for adults aged 21 and over. These benefits encompass preventive care, diagnostic services, and various restorative treatments. Covered services include annual dental exams, routine cleanings, and diagnostic X-rays. These preventive measures are crucial for maintaining oral health and identifying potential issues early.
Restorative services are also covered, such as fillings for cavities and extractions for teeth that cannot be saved. More complex procedures like root canals, crowns, and periodontal scaling are available, though some of these may require prior authorization. For instance, crowns are typically covered once every seven years per tooth, while full mouth debridement is covered once every three years. Partial and complete dentures are also included in the benefits, with replacement of lost, stolen, or irreparable dentures generally allowed once per lifetime.
A significant aspect of the adult dental benefit is that, as of July 1, 2023, there is no annual dollar limit on covered dental services for eligible members. This eliminates the previous financial cap, allowing for more comprehensive treatment when needed. Furthermore, dental benefits under Health First Colorado do not have co-pays, deductibles, or an out-of-pocket maximum, which means members generally do not incur direct costs for covered services.
Navigating Your Dental Benefits
Once enrolled in Health First Colorado, utilizing your dental benefits involves a few straightforward steps. Finding a dentist who accepts Health First Colorado is a primary consideration, as services are typically covered only when provided by an in-network provider. The state has partnered with DentaQuest to manage dental benefits, and their website (dentaquest.com) provides a search tool to locate participating dentists. You can also contact DentaQuest directly by phone at 1-855-225-1729 for assistance with finding a provider or general benefit inquiries. The Health First Colorado website also offers a provider search tool.
When scheduling an appointment, it is advisable to confirm that the dental office is accepting new Health First Colorado patients. Upon arrival for your appointment, you should bring your Health First Colorado member identification card. Your dental provider is responsible for verifying your eligibility on the date of service.
For certain procedures, such as root canals, crowns, or dentures, your dentist may need to obtain prior authorization from DentaQuest before proceeding with treatment. This process ensures the medical necessity and appropriateness of the service. While emergency dental services do not typically require prior authorization, any follow-up care or non-emergency procedures necessitating pre-approval will be managed by your dental provider.