October 16, 2014

If you live in Massachusetts and are one of the four Americans without dental insurance, you don’t have to deprive yourself from dental care anymore. The state offers its own version of the popular Medicaid program under the name MassHealth.

MassHealth standard eligibility requirements sometimes change with updated guidelines and state laws. If you want to know how to apply for MassHealth insurance coverage and all the great benefits the plan offers, you’ve come to the right place! Dr. Dental accepts MassHealth dental insurance, and we’ve helped many patients with their MassHealth dental coverage.

What You Should Know About MassHealth

Like its counterpart, Massachusetts’ own health insurance program is designed to help low- to medium-income residents and even offers a program for HIV positive patients. The initiative also manages the Insurance Partnership for small businesses, the Children’s Medical Security Plan, Special Kids/Special Care Pilot Program, and Healthy Start.

how to apply for dental coverage with masshealth

Now if you want to apply for the MassHealth coverage, you need to be one of the following:

  • Children and their parents/caretakers
  • Adults working for small businesses
  • Unemployed adults
  • Pregnant mothers
  • Elderly people
  • Disabled individuals
  • Patients who require long-term care
  • Breast or cervical cancer sufferers
  • HIV positive patients
  • Clients of the Department of Mental Health

Even if you have health insurance, you can apply for MassHealth coverage since the Executive Office of Health and Human Services (EOHHS) assesses eligibility based on family income.

Dental Care Under MassHealth

The MassHealth Dental Program provides members of the program with numerous benefits without co-payments or coinsurance expenses. For children (under 21 years) and clients of the Department of Developmental Services (DDS), preventative and diagnostic cover is covered. Basic and major restorative services and specific Masshealth dental services are also offered.

As for adults, diagnostics and preventative dental services, extractions, emergency dental treatments, and all types of fillings for all teeth are covered. However, if you need additional services that are medically necessary, you may have to acquire prior authorization. In addition, certain services like cosmetic dentistry, dental implants and habit-breaking appliances will not be covered for both adults and children.

The MassHealth Dental Program

To be eligible for the MassHealth Dental Program, you need to be covered by one of the following programs first:

  • Basic
  • CommonHealth
  • Essential
  • Family Assistance Direct Coverage
  • Family Assistance Premium
  • Limited
  • Prenatal
  • Standard

All of these cover the categories of people mentioned earlier. However, you also need to abide by financial criteria, which differ from one category to another. Generally, Massachusetts residents under 65 with incomes under or exactly 138% (133% + 5% income disregard) of the Federal Poverty Guidelines On the other hand, HIV positive individuals with 134% – 200% FPG are eligible. You can find out more through the EOHHS website or from a Massachusetts insurance provider.

You still may have questions about MassHealth dental coverage and the process. How do I apply for Masshealth online? Where can I apply for Masshealth? How is MassHealth standard eligibility determined? What about root canals and other complex procedures? These questions are still valid and your eligibility and coverage level depends on income, the number of family members and other factors. We created a comprehensive MassHealth dental guide for more information – click here to learn more.

If you have additional questions about how to apply for dental medicaid, what does Masshealth cover, does Masshealth cover braces, or other concerns, please don’t hesitate to call us at 877-776-9833.

With the federal government’s support and MassHealth’s assistance, you can now get affordable dental care. Our Dr. Dental clinics across the state welcome MassHealth members, including:

Looking to learn more about MassHealth dental insurance benefits, coverage & plans, please visit http://www.mass.gov/eohhs/consumer/insurance/

29 Comments

  1. David Routhier

    I am a MassHealth Standard member. Do I need to apply for dental benefits or am I currently covered? I need to see a dentist ASAP as a new patient.

  2. Patti Lamson

    My 22 yr old son lives in Massachusetts with me, but has health insurance from his dad in ct but no dental insurance. .can he apply for ma health dental? He is currently unemployed

  3. drdental Post author

    Hi Patti,

    I believe under those circumstances your son can apply, but it would be best to call Masshealth @ 1.800.207.5019 just to be safe and ask them directly about the process.

  4. drdental Post author

    Hi David,

    If you can call an office close to you, we can run your Masshealth ID and see if you have dental coverage

  5. Rich

    Hello,
    Who do I contact to find out my eligibility like above I tried the Mass health website but that proved to be a useless attempt When I put in all the required info and click search nothing happens. I’m 49 years old I have Mass health, my dentist said I need to remove all my teeth he set up an appointment in Brockton However I’m worried as when I asked if my dentures will be covered he said We can work something out.
    I’m also concerned because no one took any imprints of my existing teeth so if they plan on making dentures don’t they need an imprint of what they are and their positioning?
    Or is the Technology so advanced these days that they do not need any imprint of the existing teeth?
    At present, I’m only missing four teeth total one tooth in the back of each corner of my mouth one in the back the top left . one in the back top right, one in the back of lower left, and one in the back of lower right My fear is if once they remove my teeth I’m going to be left hanging so to speak with no teeth Also are implants covered ?

  6. drdental Post author

    Hi Rich,

    Thanks for reaching out.

    If you are unable to search on the Masshealth website to see if you are active, then the next best thing would be to call the number on the back of your Masshealth card.
    It sounds like the appointment made in Brockton was for an oral surgeon specialist. If that’s the case then the first visit is typically a consult. The second visit would be the day you get the extractions done. They do this because they need to examine the teeth they are taking out so they can book your appointment time accordingly for the day of extractions. In between those visits, you would be asked to visit the general dentist for an impression so they can work with their lab & fabricate an immediate denture. An immediate denture is NOT covered by Masshealth for this main reason: Its nice to have, because you wont be walking around without teeth and you have something to wear right away, but the lab estimates how your gum, tissue and bone will heal so there is a 50% chance the denture may fit, and a 50% chance it may not. Sometimes you just need simple adjustments and sometimes you need to get a whole new denture made once everything is 100% healed. However, Masshealth WILL cover a conventional denture. This type of denture is made 4-6 weeks after the extractions are done with 4-5 visits in total and 2 weeks in between each visit. There are more steps involved with making this denture because we take our time with it and make sure we get the proper measurements. This denture will last you a very long time as long as you come to the dentist still every 6 months so we can check the fit, and do any adjustments when needed. The down side to this is unfortunately you will have nothing to wear in the mouth until we start the denture process. If that’s something you don’t want to do, what we recommend is you pay out of pocket for the immediate denture & when the gums and tissues have healed (over a 4-6 week span) we can then start the denture process(covered by insurance). As far as implants, they are also not covered by your insurance.

    Our advice to you is to call your general dentist and find out exactly what is going on and what their recommendation to you is. After all, they are the office that knows your case and if you have any doubt on what is happening, you could always call and schedule another appointment with the Doctor just to get better and clear communication of whats going to happen so that you can be more comfortable in your coming visits.

    If you don’t currently have a dentist, we have two locations near you – in Quincy and in Braintree.

    I hope this helps and feel free to reach out/respond with any necessary questions.

    – The Team at Dr. Dental

  7. Tracy

    What type of denture is covered by Mass Health ? I am currently in a very bad situation with my dentist. I’ve been without teeth for over ten weeks because my dentist said I needed that time to heal. So just over a week and a half ago I went to have my impressions taken. All was fine and I would have to wait another week for them to come in. Ok, another week without teeth. So today 10/20/16 I was told to bring in $250.00 dollars and that the process would start. I am on Mass Health and I was told before my extractions (all teeth due to severe periodontal disease) by my dentist that it would be $500 for top ~ $500 for the bottoms. I am currently out of work and very little income but I was able to come up with the $250. Right before he would start I told the women that works there that I have the money but it wouldn’t be available until 3:30-4 pm. She told the Dr. and he came in and said he doesn’t deal with Medicare and it was all the money or nothing, and that if I wanted to go there that I should find someone else. That he didn’t like to discuss money. This was never mentioned to me at all. He said I should ask my father (which is dead) or my boyfriend for the money, but until I have it nothing further can be done. So I’ve been without teeth for over 11 weeks, severe depression and anxiety over this. I felt like a low life when I left his office. I also feel very defeated. Helpless in the Berkshires.

  8. drdental Post author

    Sorry to hear of your troubles. Please contact any of our Massachusetts offices that is most convenient for you. You can find them here: https://www.mydrdental.com/locations/. Each location offers varying services so it is best to contact them directly. Best of luck!

  9. Louise

    My daughter has mass health and delta dental. Her current dentist does not take mass health so we tried to get her braces covered under delta dental but they would cover it – i could move her to a new dentist. Do you think mass health would cover them? Or are both places looking at pretty much the same qualifications?

  10. drdental Post author

    Hi Louise, we take Masshealth and Masshealth will review all cases for approval of coverage for children under 21 years old for braces. Often times Delta Dental will pick up as a secondary insurance coverage. Ultimately we don’t decide this, the expert Dr’s that review your case at Masshealth will decide if they will cover the costs or not. They may choose to cover 100% or choose to defer some coverage to Delta Dental as well.

    Currently, we only offer Orthodontic services in our Chelsea, MA location, not sure if that meets your needs? If so, we are happy to make a free consultation appointment at 617-887-2100.

    Hope that helps!

  11. Diane Shean

    My son has no insurance & he needs dental& a physical any suggestions on where I start?

  12. Dona

    Hi my kids (17 and 15) have primary health ins from my work and secondary ins from masshealth. I was told that if Masshealth coverage for a treatment is lower than private ins. I will be responsible for the difference and for a copay unless I cancel primary ins. and keep my kids under masshesalth only. Is that true and can I do it without being questioned by masshealth

  13. James

    Hi my name is James
    I am in desperate need of a dentist I am on mass health and need extractions and dentures I have loose and broken teeth all over my mouth. What can I do ?? I am unemployed and homeless on waiting list for housing. What can I do am I covered for dentures and extractions ?? Please I am so depressed and have anxiety over this daily ?? Please help I beg you I am 55 years old.
    Thank You
    P.S. I will check email daily at library

  14. Avia

    Hi everyone. I have applied for the Masshealth card for four months now but it hasn’t arrived yet. However, when I needed to go to hospital, they told me I had masshealth coverage, so I didn’t pay anything.
    How can I find out why my card takes so long? The same with my husband. Only our daughter (18 years old) got hers.

    (ps.I came with a green card from Greece, five months ago)

  15. Linda Puzan

    I am a social worker working with a caregiver and her loved one who is 85 and he has mild to moderate dementia. He is on MassHealth Standard and has no teeth and recently had a swallowing problem due to this which caused a hospitalization. Caregiver is wondering if he would be eligible for dentures and if so what are her next steps.

  16. Linda

    I am a social worker working with a caregiver and her loved one who is 85 and he has mild to moderate dementia. He is on MassHealth Standard and has no teeth and recently had a swallowing problem due to this which caused a hospitalization. Caregiver is wondering if he would be eligible for dentures and if so what are her next steps.

  17. drdental Post author

    Hi Linda, does he have Masshealth Dental coverage? If so, based upon his age he should have coverage. Please contact the local office and they can help verify his benefits further. Or call 1-877-77-MyTeeth to arrive at your closest location to you.

  18. drdental Post author

    Hi Avia, you would have to contact Masshealth directly regarding the whereabouts of your cards. Masshealth will not allow us to speak on your behalf of insurance coverage, we can only verify coverage that you have. It is possible that your local Dr. Dental office can verify if you have coverage based on your social and birthday if you want to give us a call or stop by.

  19. drdental Post author

    Hi James, please feel free to visit the closest Dr. Dental location and we can set you up with a visit to get your dentures started right away. We will gladly help you throughout this process.

  20. drdental Post author

    Hi Diane, we have an introductory New Patient Special for $57 if he has no insurance, where he can get a cleaning and full exam. We also have a $25 special to just do a limited exam as well, no cleaning. As far as recommendations of dental insurance, perhaps one of our front desk can make reference to a couple popular options they see patients using.

  21. Jeanette Fernandes

    Hi,
    I had braces before and I had to get them taken off. Unfortunately I need to get them again. Does MassHealth cover me to get braces a second time?

  22. drdental Post author

    Hi Jeanette,

    Thanks for your reaching out. Please call Leslie at the following office: 617-887-2100. She will be the best person to assist you with that question.

  23. Randy Chase

    I am on medicare and am 58 years of age. I also have Masshealth
    Basically need dentures as all rear teeth are missing with rest of teeth going soon. My question is will massheath pay for dentures. They pay for medication that is not covered by medicare.Does this apply to dentures as well?

  24. Sally

    Does mass health cover partials for adults. And do they also cover caps?

  25. drdental Post author

    Hi Sally,

    Partial dentures they will cover, but it has to be approved first. Crowns or caps, they do not at this time.

  26. drdental Post author

    Hi Randy,

    Partial dentures they will cover, but it has to be approved first. Crowns or caps, they do not at this time.

  27. drdental Post author

    Hi Randy,

    Partial dentures they will cover, but it has to be approved first. Unfortunately for crowns or caps, they do not at this time.

  28. drdental Post author

    Hi Sally,
    Partial dentures they will cover, but it has to be approved first. Crowns or caps, they do not at this time.

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