"Medi-Cal Dental Coverage Explained"

Medi-Cal Dental Coverage – 2022 Guide

If you are currently applying for Medi-Cal Dental coverage or have been approved for coverage and have questions, we can help.

In this post, we will provide details about Medi-Cal’s dental coverage, including who is eligible, what the Denti-Cal program covers, and how to apply.

Plus, we will answer the most frequently asked questions, including share of cost, co-pays, and how to find a Denti-Cal dentist.

"Medi-Cal Dental Coverage Guide"

Table of Contents:

  • What is Medi-Cal
  • Medi-Cal Dental Coverage
  • Do I qualify for Medi‑Cal dental services?
  • How do I apply for Medi‑Cal to get dental services?
  • What Dental Care is covered under Medi-Cal Dental?
  • Medi-Cal Dental Care Phone Number
  • FAQs about Medi-Cal Dental Care

What is Medi-Cal

Medi-Cal is California’s Medicaid public health insurance program. The program provides medical, dental, and vision insurance to low-income families in California.

The program is supported by federal and state taxes.

Effective January 1, 2014, the Affordable Care Act (ACA) expanded Medi-Cal coverage to previously ineligible adults (childless, non-disabled, non-elderly).

Medi-Cal Program and Services include:

  • Children and Adults
  • Seniors and Persons with Disabilities
  • Teen Services
  • Newborn Referral
  • Long Term Care
  • Dental

Medi-Cal Dental Coverage

The Medi‑Cal Dental Program offers free or low-cost dental benefits for enrolled Medi‑Cal members.

The program covers dental services that are provided through Denti-Cal.

If your income is more than the Medi‑Cal limit for your family size, a low-cost monthly premium may be required.

Do I qualify for Medi‑Cal dental services?

The Medi‑Cal program offers a variety of benefits to members including covered dental services.

To receive dental coverage through Medi‑Cal, you must be eligible for Medi-Cal.

Your Medi-Cal eligibility determines the types of benefits you have access to through Medi‑Cal.

However, you do not need to apply separately for dental coverage because it is a part of the Medi‑Cal program.

How do I apply for Medi‑Cal to get dental services?

There are three ways to apply for Medi-Cal:

  • Online: It takes about 30 minutes to sign up for Medi-Cal online through Covered California.
  • In-person: You can enroll in person at a County Social Services Office. Additionally, California has hundreds of Medi-Cal enrollment centers and thousands of certified enrollers ready to help you apply for Medicaid.
  • Over the phone: You can request a phone call from an enroller to get free advice and apply for Medi-Cal over the phone or call 1‑800‑300‑1506.

For information on how to apply for Medi‑Cal, you can go to www.coveredca.com, view a list of county offices, or call 1‑800‑300‑1506.

What Dental Care is covered under Medi-Cal Dental?

​The Medi-Cal Dental Program covers a variety of dental services for Medi-Cal beneficiaries, such as:

  • Diagnostic and preventive dental hygiene (e.g. examinations, x-rays, and teeth cleanings);
  • Emergency services for pain control;
  • Tooth extractions;
  • Fillings;
  • Root canal treatments (anterior/posterior);
  • Crowns (prefabricated/laboratory);
  • Scaling and root planning;
  • Periodontal maintenance;
  • Complete and partial dentures; and
  • Orthodontics for children who qualify.

The following dental benefits are available for adults:

  • Exams and X-rays.
  • Cleanings.
  • Fluoride treatments.
  • Fillings.
  • Anterior root canals (front teeth).
  • Prefabricated crowns.
  • Full dentures.
  • Other medically necessary dental services.

Medi-Cal Dental Care Phone Number

If you have questions about Denti-Cal, you can contact Medi-Cal Dental using the information below:

What is the best time to call the Medi-Cal Dental Phone Number?

To contact the Medi-Cal Dental Program, call the Member Telephone Service Center at (800) 322-6384.

Medi-Cal dental program representatives are available 8:00 a.m. to 5:00 p.m., Monday through Friday to assist you.

FAQs about Medi-Cal Dental Care

Here are the most frequently asked questions about Denti-Cal coverage:

Are adults covered by Medi-Cal Dental Program?

Yes. As of January 1, 2018, the Department of Health Care Services (DHCS) restored adult dental benefits for members ages 21 and
older with full-scope dental coverage.

How long does Medi-Cal Dental cover Children?

Your child’s dental services are free or low-cost until age 21.

How do I find a Medi-Cal Dentist?

There are two ways to locate a Medi-Cal dentist near you.

Option 1 – Over the Phone

For help in finding dentists who accept new patients for the Medi-Cal Dental Program, you may call toll-free (800) 322-6384, Monday through Friday, 8:00 a.m. to 5:00 p.m.

Option 2 – Online

The easiest and fastest way to find a Medi-Cal dentist accepting new patients is online through the Medi-Cal Provider Directory.

You can search the directory by Zipcode, county, language, and Dental Specialty, as shown in the image below.

Click here to be taken to the Medi-Cal Provider Directory.

"How to find a Medi-Cal dentist"

How do I know if I have dental with Medi-Cal?

If you have any questions or need assistance in finding out if you have Medi-Cal dental coverage, call the Medi-Cal Dental Customer Service Line at (800) 322-6384.

Are Denti-Cal benefits Free?

Not entirely. Services that are included in the Medi-Cal Dental Program are free.

However, you are responsible for any Share of Cost amount.

Additionally, you are also responsible for the benefits available under the Medi-Cal Dental Program that duplicate those provided under any other contractual or legal entitlements you are receiving.

What is the Share of Cost program?

If your income is more than the Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses.

The amount that you pay is called your Share of Cost (SOC).

You may satisfy your SOC amount through any medical provider such as your doctor, dentist, pharmacy, or optometrist.

What is a Co‑Pay?

Your co‑pay is a fixed amount you pay for a service, usually at the same time you receive the service.

The co‑pay usually falls outside your covered dental services.

Also, the co-pay amount will vary based on the type of service.

For example, a dental visit might have a co-pay of $5. For some services, you may have a co-pay and a SOC.

The following services may have a co‑pay for adults with the Medi‑Cal dental benefit:

  • Non-emergency services provided in an emergency room – Co‑pay $5
  • Outpatient services – Co‑pay $1

When visiting a Medi-Cal Dentist, what do I need to bring?

Here’s what you need to bring to your Medi-Cal dentist appointment.

First, you need to bring your Medi-Cal Benefits Identification Card (BIC) to your dentist’s office at your appointment.

A copy of a Medi-Cal Benefits Identification is shown below.

"Medi-Cal Benefits Identification Card"

Your dentist will match the name and signature on your BIC with another form of identification, such as:

  • Your Social Security Number (SSN)
  • A valid California driver’s license
  • Any identification card issued by the Department of Motor Vehicles (DMV)
  • Or any other document which appears to prove your identity

If your photo ID has expired, the dental office will accept it up to six months from the expiration date.

Is there an annual limit to Medi-Cal dental coverage?

There is no yearly limit for children’s covered dental services or for adults who live in a nursing facility.

For adults 21 years of age or older, some services are limited to $1,800 per person for each calendar year.

However, there is no limit on medically-necessary procedures.

How Many People are on Medi-Cal in California?

As of June 2021, there are 14 million children and adults in California on Medi-Cal in the following categories:

Medi-Cal’s member population includes almost 14 million* children and adults, in
the following categories:

  • Children ages 0-20
  • Young adults transitioning from foster care ages 18-26
  • Adults ages 21+ with low income
  • Adults with disabilities ages 21+ (138% Federal Poverty Level) with low income
  • Pregnant women (213% Federal Poverty Level) with low income
  • Adults ages 65+ with low income

Medi-Cal Dental Coverage Summary

We hope this post on Medi-Cal Dental Coverage was helpful.

Questions?

If you have further questions about Medi-Cal, please let us know in the comments section below.

Be sure to check out our other articles about Medi-Cal and California Medicaid program, including:

Related Posts

Leave a Reply

Your email address will not be published.