One of the most often asked questions about Medi-Cal benefits is this: What Does Medi-Cal Dental Cover? What are the details of the Denti-Cal program? Does coverage include Dental Checkups, Braces, Dentures, or Dental Implants? We can help.
In this post, we will provide details about Medi-Cal’s dental coverage, who is eligible, and what it covers, plus answer the most frequently asked questions.
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 – using managed care providers.
If your income is more than the Medi‑Cal limit for your family size, a low-cost monthly premium may be required.
How do I apply for Medi‑Cal dental services?
There are three ways to apply for Medi-Cal to get dental benefits:
- 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 Does Medi-Cal Dental Cover?
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.
Denti-Cal will only provide up to $1800 in covered services per year.
However, some services are not counted towards the cap, such as dentures, extractions, and emergency
services.
Your dental provider may check with Denti-Cal to find out if you have reached the $1800 cap before treating you.
FAQs about Medi-Cal Dental Coverage
Here are the most frequently asked questions about Denti-Cal coverage:
Does Medi-Cal Dental cover Dental Checkups?
Yes. Dental check-ups are free or low-cost for Medi-Cal members eligible for dental benefits.
Additionally, Adults can have one dental check-up every year, while children can have a check-up every six months.
Does Medi-Cal Dental cover Braces?
Yes, but only in certain circumstances. The Medi-Cal Dental (Denti-Cal) program provides Orthodontic benefits only to children up to age 21 but is only provided for the following medically necessary conditions:
- Handicapping Malocclusion
- Cleft Palate/Lip
- Craniofacial Anomalies
Are Dentures covered under Medi-Cal Dental Plan?
Yes. The Medi-Cal Dental (Denti-Cal) program covers partial dentures, including denture adjustments, repairs, and relines.
Does Medi-Cal cover root canals?
Yes. The Medi-Cal dental program covers both anterior and posterior root canals.
Are Wisdom Teeth removal covered under Medi-Cal Dental?
Yes, Medi-Cal Dental covers tooth removal, including wisdom teeth removal.
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.
Who is Covered by Medi-Cal Dental?
The following low-income groups are covered by Medi-Cal Dental benefits.
Babies (0-4)
The Medi‑Cal Dental Program provides the following free or low-cost services for babies:
- Baby’s first dental visit
- Baby’s first dental exam
- Dental exams (every 6 months; every 3 months from birth to age 3)
- X-rays
- Teeth cleaning (every 6 months)
- Fluoride varnish (every 6 months)
- Fillings
- Tooth removal
- Emergency services
- Outpatient services
- Sedation (if medically necessary)
Kids (5-12)
The Medi-Cal Dental Program provides the following free or low-cost services for kids:
- Dental exams (every 6 months)
- X-rays
- Teeth cleaning (every 6 months)
- Fluoride varnish (every 6 months)
- Molar sealants
- Fillings
- Root canals
- Tooth removal
- Emergency services
- Outpatient services
- Sedation (if medically necessary)
Teens (13-17(
The Medi‑Cal Dental Program provides the following free or low-cost services for teens:
- Dental exams (every 6 months)
- X-rays
- Fluoride varnish (every 6 months)
- Molar sealants
- Teeth cleaning (every 6 months)
- Orthodontics (braces) for those who qualify
- Fillings
- Crowns*
- Root canals
- Partial and full dentures
- Scaling and root planing
- Tooth removal
- Emergency services
- Outpatient services
- Sedation (if medically necessary)
*Crowns on molars or premolars (back teeth) may be covered in some cases.
Pregnancy
As a Medi-Cal member, you are covered during your pregnancy and 12 months after the birth of your baby.
Regardless of the type of Medi- Cal you have, you are able to receive all covered dental procedures as long as you meet all criteria and requirements for the procedures.
Medi‑Cal will pay up to $1,800 in a year for covered dental services.
You may qualify for more than the $1,800 yearly limit, if you have a medical need.
The Medi‑Cal Dental Program provides the following free or low-cost services during pregnancy:
- Dental exams *
- X-rays
- Teeth cleaning *
- Scaling and root planing
- Fluoride varnish *
- Fillings
- Crowns**
- Root canals
- Partial and full dentures
- Denture relines
- Tooth removal
- Emergency services
* Every 12 months if over 21 years of age or every 6 months if under 21 years of age.
**Crowns on molars or premolars (back teeth) may be covered in some cases.
Adults (18-54)
Medi‑Cal will pay up to $1,800 in a year for covered dental services.
You may qualify for no yearly limit if you are pregnant. Dental services may go over the $1,800 limit if shown to be medically needed.
The Medi‑Cal Dental Program provides the following free or low-cost services for adults:
- Dental exams (every 12 months)
- X-rays
- Teeth cleaning (every 12 months)
- Scaling and root planing
- Fluoride varnish (every 12 months)
- Fillings
- Crowns*
- Root canals
- Partial and full dentures
- Denture relines
- Tooth removal
- Emergency services
- Sedation (if medically necessary)
*Crowns on molars or premolars (back teeth) may be covered in some cases.
Seniors (55+)
Medi‑Cal will pay up to $1,800 in a year for covered dental services. You may qualify for no yearly limit.
The Medi‑Cal Dental Program provides the following free or low-cost services for seniors:
- Dental exams (every 12 months)
- X-rays
- Teeth cleaning (every 12 months)
- Scaling and root planing
- Fluoride varnish (every 12 months)
- Fillings
- Crowns*
- Root canals
- Partial and full dentures
- Denture relines
- Tooth removal
- Emergency services
*Crowns on molars or premolars (back teeth) may be covered in some cases.
What Does Medi-Cal Dental Cover? – Summary
We hope this post on “What Does Medi-Cal Dental Cover?” – 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:
