MassHealth Dental Coverage Options and Costs

MassHealth offers various dental coverage options to help you manage your oral health costs. You can choose from three different plans: MassHealth Standard, MassHealth CommonHealth, and MassHealth Limited.

The MassHealth Standard plan covers a wide range of dental services, including routine cleanings, fillings, and extractions. You can also get coverage for crowns, bridges, and dentures.

MassHealth Standard has a co-insurance requirement of 50% for most services, with a maximum annual deductible of $50. This means you'll pay 50% of the cost after meeting the deductible.

Under MassHealth CommonHealth, you'll pay a small copayment for each dental visit.

To be eligible for MassHealth dental coverage, you'll need to meet certain income requirements or be enrolled in specific MassHealth plans. Massachusetts was one of the first states to implement "Obamacare" policies, so the administrative infrastructure is already in place to ensure optimum coverage.

You can check your eligibility by visiting the Massachusetts Virtual Gateway Self Service page and entering your personal information. Anyone enrolled in MassHealth Family Assistance, MassHealth Standard, MassHealth CommonHealth, MassHealth Limited, or CarePlus plans is eligible for dental coverage.

MassHealth uses federal poverty guidelines to determine qualification, and you can view the latest income standards on the MassHealth's legal services website. For example, a senior citizen earning $1,001 per month or a family of eight earning $10,394 per month is eligible for dental coverage.

Here are the MassHealth plans that offer dental coverage:

MassHealth dental coverage is available for adults 21 years or older who have Medicaid Standard benefits, as well as those who meet certain income requirements.

To be eligible for MassHealth Dental insurance, you'll need to check your eligibility through the Massachusetts Virtual Gateway Self Service page. You can enter your personal information to determine if you qualify.

MassHealth Dental offers coverage to individuals enrolled in certain plans, including MassHealth Family Assistance, MassHealth Standard, MassHealth CommonHealth, MassHealth Limited, and CarePlus.

Your income level is a key factor in determining your eligibility for MassHealth Dental benefits. The latest MassHealth Income Standards are based on federal poverty guidelines, which you can view on the MassHealth's legal services website.

Here are some specific income requirements for MassHealth Dental eligibility:

You can also qualify for MassHealth Dental if you're 21 years or older and have Medicaid Standard benefits, or if you meet certain income requirements and are enrolled in MassHealth CarePlus plans or Children's Medical Security Plans.

Your age can also affect your eligibility for MassHealth Dental benefits. Adults over 21 may have more limited benefits compared to children under 21, but they may still qualify for implant coverage if it's deemed medically necessary.

If you're looking for certified individual and family plans, the Massachusetts Health Connector is the place to go. They've certified individual and family dental plans from two insurers.

These plans are available all year round, which is great news if you're looking for coverage outside of the usual open enrollment period. Stand-alone dental plans are available for both children and adults through the Connector.

All insurers that offer medical plans through the Massachusetts exchange include pediatric dental coverage with their health plans. A few of these plans also offer limited adult coverage, so be sure to check those out.

Massachusetts uses a state-based health insurance exchange called the Massachusetts Health Connector for the sale of certified individual/family dental plans as well as small-group dental options.

All insurers that offer medical plans through the Massachusetts exchange include pediatric dental coverage with their health plans, and a few offer limited adult coverage.

Stand-alone dental plans are available for both children and adults through the Connector all year.

To give you an idea of the services covered under MassHealth dental plans, here's a list of the care categories included:

Your specific MassHealth plan type can also affect the coverage of dental implants and restorative procedures.

You can purchase dental insurance through the Massachusetts exchange, and premiums range from $12 to $57 per month for adults.

Two insurers offer stand-alone individual/family dental coverage through Massachusetts Health Connector: Altus Dental and Delta Dental. These plans can be purchased at any time of the year, not just during open enrollment or a special enrollment period.

If you're looking for more options, there are also non-ACA qualified dental plans available for purchase directly from insurers, which can be found by asking a dentist for recommendations or searching online.

Stand-alone pediatric dental plans on the exchange are ACA-compliant.

All insurers that offer medical plans through the Massachusetts exchange include embedded pediatric dental coverage.

To purchase a stand-alone dental plan for someone under 19 years old without medical coverage, you must contact the exchange directly.

The out-of-pocket costs for pediatric dental care will not exceed $400 per child in 2024 (or $800 for all the children on a family’s plan) if a stand-alone dental plan is sold through MA Health Connector.

Embedded pediatric dental out-of-pocket costs vary by carrier, but there is no limit on how much the plan will pay for pediatric dental care if it's an essential health benefit.

Medical plans sold through MA Health Connector include embedded pediatric dental benefits.

Stand-alone dental plans can be purchased for children who do not have health coverage through the exchange.

The specific coverage requirements for pediatric dental care are guided by the state’s essential health benefits benchmark plan, which includes coverage for both basic and major dental services for children.

If you're looking for dental coverage through the Massachusetts marketplace, you have a couple of options. Adult and family dental coverage is not automatically included with medical plans from insurers who offer coverage through Massachusetts's health insurance Marketplace.

There are two insurers that offer stand-alone individual/family dental coverage through Massachusetts Health Connector. These are dental plans that must be purchased separately and are not included with a medical plan.

The two insurers that offer stand-alone dental coverage are Altus Dental and Delta Dental. Plans from insurers may not be offered in all areas.

You can purchase these dental plans through the Massachusetts exchange at any time during the year, not just during open enrollment or a special enrollment period triggered by a qualifying life event.

Dental insurance premiums in Massachusetts can range from about $12 to $57 per month for adults who purchase their own stand-alone coverage through the exchange.

If you're a MassHealth recipient, you're in luck - dental implants may be partially or fully covered if deemed medically necessary to restore your oral health.

However, it's essential to note that MassHealth typically covers dental implants for functional reasons, not cosmetic ones, and there may be additional expenses associated with the procedure, such as bone grafting, dental imaging, medications, and surgical guides.

These out-of-pocket expenses can add up, so it's crucial to discuss them with your dentist and insurance provider beforehand to plan accordingly.

MassHealth covers a variety of dental services, including cleanings, X-rays, and procedures to reverse and treat dental decay and gum disease. These services are essential for maintaining good oral health.

Children enrolled in MassHealth are entitled to two dental cleanings per year, which include removing plaque, floss, and cleaning the teeth to prevent future build-up of plaque. Routine X-rays are also covered and help with dental exams.

MassHealth covers dental sealants for adult molars, which can protect teeth from cavities. This is a form of tooth decay prevention that is often done on adult molars.

A dental filling can be used to stop a cavity from growing by removing the infected section of the tooth and filling it with a different material. This is a common procedure covered by MassHealth.

If you have lost a tooth due to injury or disease and it needs to be replaced for functional reasons, your implant procedure may be partially or fully covered by MassHealth. This is because MassHealth covers dental implants if they are deemed medically necessary to restore your oral health.

The following services related to dental implants may be covered by MassHealth if deemed medically necessary:

It's essential to note that these services must be deemed medically necessary by your dentist in order for them to be covered by MassHealth.

Insurance costs can vary greatly depending on the state and type of coverage. In Massachusetts, adults who purchase stand-alone dental coverage through the exchange can expect to pay between $12 and $57 per month.

Some states may offer more affordable options, but others may have higher premiums. For example, in Massachusetts, the range of premiums for stand-alone dental coverage is quite broad.

To give you a better idea, let's look at the specifics in Massachusetts. For adults who purchase their own stand-alone dental coverage through the exchange in Massachusetts, premiums in 2025 range from about $12 to $57 per month.

Masshealth covers dental implants if they're deemed medically necessary to restore your oral health. This means if you've lost a tooth due to injury or disease and it needs to be replaced for functional reasons rather than cosmetic ones, your implant procedure may be partially or fully covered.

Masshealth is a state-run program that provides health insurance coverage to low-income individuals and families in Massachusetts. It's also known as the Massachusetts Health Insurance Program.

To get a dental implant covered by Masshealth, you need to meet specific criteria and receive approval from both your dentist and MassHealth provider services department before undergoing treatment. This ensures you're eligible for partial or complete coverage of your implant procedure.

Dental implants can cost a lot, even with insurance coverage. In addition to the procedure cost, you may need to pay for extra expenses like bone grafting, dental imaging, medications, surgical guides, anesthesia, and final restoration.

MassHealth dental coverage has a lot to offer. You can get certified individual and family dental plans through the Massachusetts Health Connector, which is a state-based health insurance exchange.

All insurers that offer medical plans through the Massachusetts exchange include pediatric dental coverage with their health plans. A few also offer limited adult coverage.

Stand-alone dental plans are available for both children and adults through the Connector all year. This means you can choose a plan that meets your specific needs.

The MassHealth dental benefits cover a range of services, including oral exams, X-rays, crowns, cleanings, extractions, and more. Here are some of the specific services covered:

Keep in mind that this is a general list of services, and there may be some differences between child and adult dental care. For a detailed description of the differences, you can consult the MassHealth Dental Benefit Booklet.