Can I Get My Wisdom Teeth Removed With Medicaid?
- Medicaid covers wisdom teeth extraction in some states, though it may not in others. Learn how to find out if your tooth removal will be covered by your state’s Medicaid program.
Medicaid covers wisdom teeth extraction in some states, though the level of coverage and whether Medicaid covers dental services at all can vary from one state to the next. Some state Medicaid programs only cover emergency extractions.
Medicaid programs are not required to provide dental benefits to adults on Medicaid, as dental services are an optional Medicaid benefit. Thus, there are some states where something like a wisdom tooth extraction may be covered by Medicaid for both children and adults, and there are other states where it may only be covered for children but not for adults.
State Medicaid programs are required by federal law to provide dental benefits to children who are covered by Medicaid or the Children’s Health Insurance Program (CHIP).
Does Medicaid Cover Tooth Extraction for Children?
State Medicaid programs must include a minimum set of dental benefits for children that include:
- Relief of pain and infections
- Teeth restoration
- Maintenance of dental health
While wisdom tooth extractions are not included as part of the minimum requirements, many state Medicaid programs include benefits that go above and beyond the minimum federal requirements and may cover the cost of a wisdom tooth for a child with Medicaid.
What Dental Benefits Does Medicaid Cover for Adults?
There is no federal law that requires state Medicaid programs to provide any dental benefits to adults.
According to the Center for Health Care Strategies, Inc. (CHCS), only four states do not cover dental benefits for adults with Medicaid: Alabama, Delaware, Maryland and Tennessee.
All other states offer either limited, extensive or emergency-only benefits. If a wisdom tooth is impacted and causing a great deal of pain or discomfort, an extraction will generally be considered an emergency procedure and may be covered in many states.
However, if the wisdom teeth are growing properly and not causing any pain or discomfort, it is unlikely to be categorized as an emergency procedure and may not be covered.
According to the CHCS, the list of states that offer “extensive” dental benefits to adults with Medicaid include:
- District of Columbia
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
States with “limited” dental benefits for adults with Medicaid according to the CHCS include:
- South Carolina
- South Dakota
Lastly, states that offer “emergency-only” dental benefits to adults with Medicaid according to the CHCS include:
- New Hampshire
- West Virginia
Contact your state Medicaid program directly to find out if Medicaid covers wisdom teeth extraction where you live.
Learn more about Medicaid by reading our Guide to Medicaid.
Is Wisdom Tooth Extraction Covered by Medicare?
Original Medicare (Part A and Part B) does not provide coverage for routine dental care, and thus Medicare does not typically provide any coverage for a wisdom tooth removal.
Original Medicare does cover certain dental care in emergency situations when deemed medically necessary, and thus there may be limited circumstances under which a wisdom tooth removal might be covered.
Medicare Advantage (Medicare Part C) plans may often include routine dental coverage, which may typically include coverage for wisdom tooth extractions.