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Your Medicaid dental coverage

Babies, children, and adults should see a dentist twice a year. Brushing, flossing, and avoiding sugary food and drinks can help keep your teeth and gums healthy.

Child smiles as she listens to a dental healthcare provider.

Why dental care is important

Part of being healthy is oral health care. Problems with your teeth can affect your overall health. Tooth problems can cause problems like:

  • Not being able to bite and chew food
  • Missing school or work because of pain
  • Having trouble speaking, especially if you have unhealthy teeth

Regular visits with your dentist can help prevent problems before they develop. If you have problems with your teeth or gums, a dentist can diagnose and treat you.

Picking a dental plan

Medicaid recipients in Florida can pick from three statewide dental plans1:

To pick or change a dental plan:

  • Go to FLMedicaidManagedCare.com
  • Call 1-877-711-3662 to speak with a Florida Medicaid Choice Counselor

Once enrolled in a plan, the plan itself can help you:

  • Choose or change your dentist
  • Find out if a service is covered
  • Get referrals
  • Find a provider
  • Replace a lost dental ID card
  • Explain any changes that may affect your dental benefits

Once you pick a dental plan, your dental plan will send you a dental ID card. This ID card will not come with your health plan member ID card. Your Florida Medicaid Choice Counselor or the dental plan you pick can talk to you more about when to expect your dental ID card to come in the mail.

Dental care for children

Florida Medicaid wants to help keep children healthy. Children with Medicaid in Florida get the following dental services at no cost:

  • Dental exams
  • Dental screenings
  • Dental X-rays
  • Teeth cleanings
  • Fluoride treatment
  • Sealants
  • Oral health instructions
  • Space maintainers
  • Fillings and crowns
  • Root canals
  • Periodontics (e.g., gum disease treatment)
  • Prosthodontics (e.g., dental prostheses)
  • Orthodontics (e.g., braces)
  • Extractions (removal of teeth)
  • Sedation (dental services while asleep or partially asleep)
  • Ambulatory surgical center or hospital-based dental services

Some services require your dental plan’s permission. This is called prior authorization. Services must be medically necessary for a dental plan to pay. Your dental plan can tell you if a service your dentist suggests is covered.

Dental care for adults

For Florida Medicaid members who are 21 and older, your dental plan will cover emergency-based dental services, including:

  • Dental exams (limited)
  • Dental X-rays (limited)
  • Dentures
  • Extractions (removal of teeth)
  • Sedation (dental services while asleep or partially asleep)
  • Problem focused
  • Pain management

Some services require your dental plan’s permission. This is called prior authorization. Services must be medically necessary for a dental plan to pay. Your dental plan can tell you if a service your dentist suggests is covered.

You may be eligible to receive additional services. For example, our pregnant members who are 21 and older may be able to get extra dental services to help with a healthy pregnancy. Ask your dental plan if it provides any or all of the following services:

  • Additional dental exams
  • Dental screenings
  • Additional dental X-rays
  • Teeth cleanings (basic and deep)
  • Fluoride sealants
  • Oral health instructions
  • Fillings (silver and white)
  • Additional extractions
  • Dental consultations
  • Dental office diabetic testing
  • A visit to the dental office to get comfortable with the office and the dentist before dental work, for people with disabilities

When We Pay for Your Dental Services

Your dental plan will cover most of your dental services, but we may cover some dental services for you. The following table will help you to decide which plan pays for a service.

Type of dental service(s): Dental plan covers: Dental plan covers: Dental Services (see list of services above) Covered when you see your dentist or dental hygienist Covered when you see your doctor or nurse (e.g., for oral surgery, such as a tooth extraction) Scheduled dental services in a hospital or surgery center Covered for dental services by your dentist Covered for doctors, nurses, hospitals, and surgery centers Hospital visit for a dental problem Not covered Covered Prescription drugs for a dental visit or problem Not covered Covered Transportation to your dental service or appointment Not covered Covered

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