1. Barrier Busters: Ten Things To Know About Dental Options
Ruth Kraut
Washtenaw Health Plan
(734)

2. 1. Medical and Dental Insurance Work Differently
Dental insurance always has a cap on benefits, after that you pay everything; with medical insurance once you hit a cap, everything is covered
Dental insurance benefits may require you to be enrolled for a certain period; medical insurance is based on necessity

3. 2. Dental insurances are usually “extra”
Medicare, VA coverage—you may buy dental as an extra policy
Private and employer coverage—dental is generally a separate policy, may be bought separately
Marketplace—separate policy except some higher-end plans cover pediatric dental
Medicaid—a limited benefit is included

4. 3. Medicaid is a poverty program
For most dental insurance (private, employer, Medicare, Marketplace), you must buy it during open enrollment—and you must pay
Medicaid—any time of the year; all benefits available immediately—it is free

5. 4. Diagnostic & Preventive Benefits: Always Covered
All dental plans will cover diagnostic & preventive care. Generally, this includes:
X-rays
Cleanings
Oral exams
Often, fluoride treatments are included

6. 4. Dental Benefits Are “Tiered”
These may vary, but generally…
Preventive and Diagnostic
Tier 1: Fillings, Extractions
Tier 2: Root Canals, Crowns
Needs prior authorization or has other limits—dentures, orthodontics

7. 5. Private Insurance Doesn’t Cover Everything! (Cap)
Different tiers get paid at different amounts (50% to 100%)
Orthodontia (braces)usually has a lifetime cap
Annual per-person cap may be $750 to $1500 (easy to hit it!)

8. 6. Medicaid Benefits Don’t Cover Everything (Procedures Excluded)
Instead of a maximum dollar amount, they don’t cover certain types of benefits
There is some variability in what is covered, depending on the type of Medicaid (example: root canals are covered for kids only)
Preventive, Emergency, and Diagnostic Benefits covered
Fillings and Extractions Are Covered
Dentures require preauthorization
Orthodontia (braces) only covered based on severe medical necessity—generally, Childrens’ Special Health Care Services (e.g., cleft palate)

9. 7. Confused? Look At The Type Of Medicaid
Ages 0-20: Healthy Kids Dental
Delta Dental
Blue Cross Complete
Ages 21-64, not disabled:
HMP: Dental goes with the HMP Managed Care Plan
Low Income Family: may have fee for service Medicaid
Age 65+, or disabled: will have fee for service Medicaid
First month or two of HMP/HK/MIChild, or as a secondary insurance, may have Fee For Service Medicaid
CSHCS may have additional benefits for kids with disabilities that affect their mouths (e.g. saliva problems)

10. Two Examples: Use Medicaid Lookup
Jane is a single mom with an income of $10,000/year. She gets Medicaid for Low Income Families and chooses Molina Health Plan. Her dental coverage is Fee For Service.
Mary is a single mom with an income of $20,000/year. She gets Healthy Michigan Plan and after a month chooses Molina Health Plan. Her dental coverage after the first month (chosen by Molina) is Delta Dental.

11. 8. Extraction? Or Root Canals & Crown?
If you have the root canal w/o the crown, the root canal will fail
Most private insurances will cover these at somewhere between 50% and 80%, with a cap on payment between $750 and $1000. Most people w/ private insurance will pay $750 or so for the root canal & crown. Extractions generally covered 80% to 100%
Most of the time, Medicaid will not pay (in some cases—e.g. kids—yes with preauthorization).
People with Medicaid can always pay on their own for non-covered services
Generally the alternative to the root canal/crown is an extraction. This is typically covered at 100% or 80%.

12. 9. Dentures Dentures are covered by both private and public insurance.
Generally need pre-authorization.
Generally only covered 1x/5-7 years.
Private insurance: subject to maximum payments
Public insurance: cannot get temporary dentures AND final dentures

13. 10. Prevention > Emergency Services
Many low-income people have not been to the dentist in a long time
They go to the dentist (or the ER, or doctor) only during emergencies
This leads to pain while at dentist, and loss of teeth that could be saved, and then they don’t go to the dentist…
Message your clients: Prevention matters. It can improve physical health as well as oral health. And yes, that includes eating well, brushing and flossing!

14. Medicaid Networks & Fee Schedules
Lowest rates: Fee for Service—and therefore, also, the smallest network.
Best bets in Washtenaw County: Washtenaw County Dental Clinic, UM Dental School
Highest rates: Healthy Kids Dental—and therefore, the largest network.
75%-80% of general dentists take this
Pediatric benefit covers more items
Some plans offer the basics, but pay dentists more. These have more dentists enrolled. [Example: McLaren with Delta Dental]
Some plans offer more, but pay dentists less. These have fewer dentists enrolled. [Example: Blue Cross Complete with DenCap.]
BCC will cover some periodontal procedures and pre-authorized root canals

15. Washtenaw County Dental Clinic
111 N. Huron St. Ypsilanti, MI
Medicaid: Takes nearly all types, including FFS, but not Blue Cross Complete DenCap.
Uninsured: Has discounted “sliding fee scales” available
Washtenaw County Dental Fund—for people without insurance, $200 + cost of initial exam at the WCDC. (Enrollment through WHP.)

16. University of Michigan Dental School
Emergency Dental Clinic
Call or , select option #1; Monday - Friday 9:00 am to 5:00 pm
Community Dental Clinic
Specialty Clinics (Oral Surgery)
Clinic for people with developmental disabilities

17. Questions? Ruth Kraut 555 Towner, Ypsilanti, MI 48198 (734) 544-3068