Does Medicaid Cover Dental and Vision Care? Here’s What You Need to Know

If you have ever asked yourself, ‘Does Medicaid cover dental and vision care?’ you are not alone. The truth is, there’s no one-size-fits-all answer. Coverage depends on your age and where you live. While children often receive more comprehensive benefits, adults face a patchwork of rules that vary from state to state.

This guide explains everything you need to know about Medicaid dental and vision benefits. We will cover state differences, children’s coverage, and Medicare options. You will learn how to access these essential health services. 

Understanding your coverage helps you get proper care. Let’s explore what Medicaid offers for your dental and vision needs.

How to Get Dental and Vision Care Coverage When You Have Medicare

Medicare and Medicaid work differently for dental and vision care. Many people have both programs. Understanding each program helps you get better coverage. Medicare covers very few dental services. Medicaid may fill some gaps.

Does Medicare Cover Dental Care?

Medicare does not cover most dental services. In most cases, Medicare doesn’t cover dental services like routine cleanings, fillings, tooth extractions (removals), or items like dentures and implants. Regular checkups are not covered. 

Teeth cleaning is not included. Fillings and crowns are excluded. Only hospital dental procedures may be covered. This happens when you are admitted to the hospital. The dental work must be medically necessary.

Does Medicare Cover Vision Care?

Medicare covers minimal vision services. Eye exams for diabetes are covered. Glaucoma testing is included. Most routine eye exams are excluded. Glasses and contacts are not covered. Eye surgery may be covered if medically necessary. Cataract surgery is usually covered.

Getting Medicare Coverage for Dental, Vision & Hearing

Medicare Advantage plans may offer extra benefits. Some plans include dental coverage. Vision benefits might be available. Hearing aids could be covered. These benefits vary by plan. You must choose carefully during enrollment.

Do Medicare Advantage Plans Cover Dental and Vision?

Many Medicare Advantage plans offer dental and vision benefits. These plans replace Original Medicare. They often include extra services. Dental coverage may consist of cleanings. Vision benefits cover eye exams. Some plans pay for glasses. Coverage limits still apply. Check each plan’s specific benefits.

Does Medicaid Include Dental and Vision Care?

Yes, Medicaid covers dental and vision care, but coverage varies significantly. States are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP). 

But states choose whether to provide dental benefits for adults. Children have guaranteed comprehensive dental coverage nationwide. Adults may receive comprehensive, limited, or emergency-only dental coverage. Vision coverage varies dramatically by state and age group.

Routine vs Medically Necessary Dental Care

Medicaid separates dental care into two types. Routine care includes regular checkups. Medically necessary care treats urgent problems. Children get both types of care. Adults may only get emergency care. Some states offer comprehensive adult coverage. 

While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care.

Medicaid Coverage for Dental and Vision Care

Complete state-by-state Medicaid adult dental and vision coverage:

State	Adult Dental Coverage	Vision Coverage	State Medicaid Website
Alabama	None	None	Alabama Medicaid
Alaska	Emergency Only	Eye Exams & Glasses	Alaska Medicaid
Arizona	Emergency Only	No Coverage	Arizona Medicaid
Arkansas	Limited Services	Eye Exams Only	Arkansas Medicaid
California	Extensive	Full Coverage	California Medi-Cal
Colorado	Extensive	Eye Exams & Glasses	Colorado Medicaid
Connecticut	Extensive	Full Coverage	Connecticut HUSKY
Delaware	No	Eye Exams & Glasses	Delaware Medicaid
Florida	Emergency Only	Limited Coverage	Florida Medicaid
Georgia	Emergency Only	Limited	Georgia Medicaid
Hawaii	Emergency Only	Eye Exams & Glasses	Hawaii Medicaid
Idaho	Extensive	No Coverage	Idaho Medicaid
Illinois	Extensive	Full Coverage	Illinois Medicaid
Indiana	Limited Services	Eye Exams Only	Indiana Medicaid
Iowa	Extensive	Eye Exams & Glasses	Iowa Medicaid
Kansas	Limited Services	Limited	Kansas KanCare
Kentucky	Limited Services	Eye Exams Only	Kentucky Medicaid
Louisiana	Limited Services	Eye Exams & Glasses	Louisiana Medicaid
Maine	Emergency Only	Full Coverage	Maine Medicaid
Maryland	None	Eye Exams & Glasses	Maryland Medicaid
Massachusetts	Extensive	Full Coverage	MassHealth
Michigan	Limited Services	Eye Exams & Glasses	Michigan Medicaid
Minnesota	Limited Services	Full Coverage	Minnesota Medicaid
Mississippi	Limited Services	Limited	Mississippi Medicaid
Missouri	Limited Services	Limited	Missouri Medicaid
Montana	Extensive	Eye Exams & Glasses	Montana Medicaid
Nebraska	Limited Services	Eye Exams Only	Nebraska Medicaid
Nevada	Emergency Only	Eye Exams & Glasses	Nevada Medicaid
New Hampshire	Emergency Only	Eye Exams & Glasses	New Hampshire Medicaid
New Jersey	Extensive	Full Coverage	NJ FamilyCare
New Mexico	Extensive	No Coverage	New Mexico Medicaid
New York	Extensive	Full Coverage	New York Medicaid
North Carolina	Extensive	Full Coverage	North Carolina Medicaid
North Dakota	Extensive	Eye Exams & Glasses	North Dakota Medicaid
Ohio	Extensive	Eye Exams & Glasses	Ohio Medicaid
Oklahoma	Emergency Only	No Coverage	Oklahoma Medicaid
Oregon	Extensive	Full Coverage	Oregon Health Plan
Pennsylvania	Limited Services	Eye Exams & Glasses	Pennsylvania Medicaid
Rhode Island	Extensive	Eye Exams & Glasses	Rhode Island Medicaid
South Carolina	Limited Services	Limited	South Carolina Medicaid
South Dakota	Limited Services	Limited	South Dakota Medicaid
Tennessee	None	No Coverage	TennCare
Texas	Emergency Only	Limited	Texas Medicaid
Utah	Emergency Only	Eye Exams Only	Utah Medicaid
Vermont	Limited Services	Full Coverage	Vermont Medicaid
Virginia	Emergency Only	Eye Exams Only	Virginia Medicaid
Washington	Extensive	Full Coverage	Washington Apple Health
West Virginia	Emergency Only	Eye Exams & Glasses	West Virginia Medicaid
Wisconsin	Extensive	Eye Exams & Glasses	Wisconsin Medicaid
Wyoming	Emergency Only	Limited	Wyoming Medicaid

Vision Coverage Legend:

• Full Coverage: Eye exams, glasses, contacts, surgery
• Eye Exams & Glasses: Annual exams plus prescription eyewear
• Limited: Emergency eye care only
• No Coverage: No adult vision benefits

Medicaid and Medicare Enrollees Need Dental, Vision, and Hearing Benefits

Many people need both Medicare and Medicaid coverage. These are called dual-eligible beneficiaries. They often have the most significant health needs. Both programs have coverage gaps. Most Medicaid or Medicare enrollees do not have comprehensive health coverage for vision, dental, or hearing benefits.

Medicare and Medicaid Coverage of Dental, Vision, and Hearing Benefits Is Very Limited

Current coverage leaves many people without the necessary care. Both programs focus on medical care. Dental and vision are treated separately. This creates barriers to comprehensive care.

Medicare

Medicare was designed for medical care only. Dental services were excluded from the beginning. Vision coverage is minimal. Most beneficiaries need supplemental insurance. Medicare Advantage may help fill gaps.

Medicaid

Medicaid adult coverage varies significantly by state. There are no minimum requirements for adult dental coverage. Some states offer comprehensive benefits. Others provide only emergency care. Children always get better coverage through Periodic Screening, Diagnostic, and Treatment (EPSDT).

Lack of Access to Dental, Vision, and Hearing Benefits Affects Enrollees’ Health

Missing dental care leads to serious problems. Tooth infections can become life-threatening. Vision problems affect daily activities. Poor oral health is linked to heart disease. Untreated conditions worsen over time. Emergency room visits increase costs.

Low-Income Adults and People of Color More Likely to Have Unmet Needs for Dental Care

Health disparities affect vulnerable populations the most. Low-income adults struggle to afford care. People of color face additional barriers. Geographic location limits provider access. Transportation creates another obstacle.

Clear Answer: Does Medicaid Cover Dental and Vision Care?

YES, but coverage depends on your age and state:

For Children (Under 21)

• Dental: ALL 50 states provide comprehensive dental coverage through Periodic Screening, Diagnostic, and Treatment (EPSDT)
• Vision: ALL 50 states offer eye exams, glasses, and treatment through Periodic Screening, Diagnostic, and Treatment (EPSDT)
• Coverage includes: Cleanings, fillings, extractions, braces (when medically necessary), eye exams, glasses, and contacts.

For Adults (21 and older)

• Dental: In most states, Medicaid covers at least some dental care for enrollees who are 21 and older, although several states limit this coverage to emergencies
• Vision: In 20 states, fee-for-service Medicaid policies did not cover glasses at all, and in 12 of those states, eye exams were also not covered

Current Statistics

• 39 states + DC provide adult dental coverage beyond emergencies
• Eight states provided coverage for both exams and glasses at least annually, 18 states covered them biannually, and three states covered them less frequently than every 2 years
• While Medicaid programs are required to cover dental services for children and youth under age 21, they are not required to do so for adults

Program Expansions and Recent Changes

• New York State Medicaid Expansion: New York offers comprehensive adult dental and vision coverage, including routine cleanings, fillings, crowns, and annual eye exams, with coverage for glasses. Visit: https://www.health.ny.gov/health_care/medicaid/ 
• Florida Enhanced Dental Programs: Florida has expanded managed care dental programs for adults. Enhanced services now include preventive care and basic restorative treatments. Visit: https://www.myflfamilies.com/service-programs/access-florida-food-medical-assistance-cash/
• Tennessee Adult Dental Expansion: Tennessee recently expanded adult dental services beyond emergency care, now covering cleanings, fillings, and extractions for qualified adults. Visit: https://www.tn.gov/tenncare.html 

Other Notable Expansions:

• Connecticut: Added periodontal services in 2024
• Oregon: Maintains comprehensive coverage through the Oregon Health Plan
• California: Full adult dental and vision benefits

Licensing All Qualified Providers Would Expand Access to Needed Dental Care

Provider shortages limit access to care. More licensed providers could serve Medicaid patients. An expanded scope of practice would help. Dental hygienists could provide more services.

Medicaid Enrollees Need Access to Dental, Vision, and Hearing Services

All states should expand adult Medicaid benefits. Comprehensive coverage would improve health outcomes. Federal standards could ensure consistent access. Adequate reimbursement rates would attract providers.

Periodic Screening, Diagnostic, and Treatment (EPSDT) Vision Dental Coverage Children – Mandatory Benefits

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) provides comprehensive care for children. Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.

Mandatory EPSDT Benefits Include:

• Comprehensive dental services
• Vision screening and treatment
• Hearing assessments
• Mental health services
• Physical health screenings

Periodic Screening, Diagnostic, and Treatment (EPSDT) requires that all services covered under the Medicaid program must be provided to Periodic Screening, Diagnostic, and Treatment (EPSDT) recipients if determined to be medically necessary.

EPSDT vs Adult Coverage:

Service Type	Children (EPSDT)	Adults
Dental Exams	Required	Optional by State
Vision Screening	Mandatory	Limited
Treatment Coverage	Comprehensive	Emergency Only
Preventive Care	Full Coverage	Varies

Vision services, at a minimum, include diagnosis and treatment for defects in vision and eyeglasses when appropriate.

How to Use Your Dental and Vision Benefits

Understanding your benefits helps you get proper care. Each state has different rules. Contact your Medicaid office for specific information. Ask about covered services before treatment.

Dental Benefits

Check which dental services are covered. Find providers who accept Medicaid. Some states require referrals for specialists. Emergency care is usually available immediately. Routine care may have waiting periods.

Covered Dental Services May Include:

• Emergency extractions
• Pain relief treatments
• Infection treatments
• Routine cleanings (in some states)
• Basic restorative work

Vision Benefits

Vision coverage varies significantly by state. Eye exams may be covered annually. Glasses might be provided when medically necessary. Contact lens coverage is rare.

Common Vision Benefits:

• Annual eye examinations
• Prescription eyeglasses
• Treatment for eye diseases
• Vision therapy (when appropriate)

Get Extra Benefits and Paid Rewards for Dental and Vision Care!

Some managed care plans offer additional benefits. Rewards programs encourage preventive care. Transportation assistance may be available. Health education programs provide valuable information.

State Medicaid Adult Dental Coverage by State Comparison

Comprehensive Adult Coverage States:

• California: Full dental benefits
• Connecticut: Extensive coverage
• New York: Comprehensive services
• Illinois: Broad dental benefits

Limited Adult Coverage States:

• Texas: Emergency only
• Alabama: Minimal services
• Mississippi: Basic coverage
• Wyoming: Emergency care only

Program Expansions:

• Tennessee: Recently expanded adult dental benefits
• Florida: Enhanced managed care dental programs
• New York: Comprehensive adult dental and vision coverage

Frequently Asked Questions

Does Medicaid pay for dental and vision?

Yes, but coverage varies by state and age. Children get comprehensive coverage through Periodic Screening, Diagnostic, and Treatment (EPSDT). Adults may only receive emergency dental care. Vision coverage is limited for most adults.

Does Medicaid in GA cover dental?

Georgia Medicaid covers emergency dental services for adults. Children receive comprehensive dental care through Periodic Screening, Diagnostic, and Treatment (EPSDT). Routine cleanings for adults are not typically covered.

Does Medicaid in Oregon cover dental?

Oregon provides more comprehensive adult dental coverage. The Oregon Health Plan includes many dental services. Children receive full Periodic Screening, Diagnostic, and Treatment (EPSDT) dental benefits.

Why don’t most dentists accept Medicaid?

Low reimbursement rates discourage many dentists. Administrative burdens create additional challenges. Payment delays affect cash flow. Complex prior authorization requirements add complications.

What does Medicaid not cover?

Medicaid typically excludes cosmetic procedures. Routine adult dental care varies by state. Most vision services for adults are excluded. Experimental treatments are generally not covered.

Conclusion

So, does Medicaid cover dental and vision care? Yes, but coverage varies significantly. Children under 21 receive comprehensive Periodic Screening, Diagnostic, and Treatment (EPSDT) vision and dental coverage benefits in all states. This includes regular checkups, treatments, glasses, and necessary dental work. 

Adult coverage through state Medicaid dental and vision coverage programs varies dramatically by location. Some states provide comprehensive adult benefits. Others offer only emergency dental care. Medicaid adult dental coverage by state ranges from complete services to emergency-only treatments.

Understanding your state’s specific policies helps you access available healthcare services. Check the state links provided above for detailed coverage information. Early prevention saves money and improves health outcomes for everyone.