Does Louisiana Medicaid Cover Wisdom Teeth Removal?
Louisiana Medicaid may cover wisdom teeth removal, depending on your age, symptoms, and Medicaid benefits. For people age 20 and younger, symptomatic wisdom teeth can be covered. For adults 21 and older, coverage varies by the type of care needed and the person's Medicaid plan.
A dentist or oral surgeon may need to show why the tooth needs to be removed. Some procedures also require approval from Medicaid before treatment.
When Is Wisdom Teeth Removal Covered for Children and Teens?
Louisiana Medicaid covers the removal of symptomatic wisdom teeth for members age 20 and younger through its children's dental benefit. The state's dental rules specifically include simple and surgical extractions, including removal of impacted teeth.
A wisdom tooth may need treatment if it is causing problems such as pain, swelling, infection, or other dental concerns. Louisiana Medicaid guidance states that third molars, or wisdom teeth, are reimbursable when they are symptomatic, and the symptoms must be documented in the patient's dental record.
The dentist may take X-rays to see how the tooth is growing and whether it is impacted. Depending on the procedure, approval may be needed before the tooth is removed.
Is Wisdom Teeth Removal Covered for Adults?
For adults age 21 and older, wisdom teeth coverage depends on your Medicaid benefits and why the tooth needs to be removed. Louisiana's standard adult dental program is limited, but some Healthy Louisiana health plans offer extra dental coverage that includes extractions.
For example, adult dental extras are currently offered by several Medicaid health plans, but the covered services, provider network, and yearly limits differ.
Adults enrolled in Louisiana's Adult Waiver Dental Program have more complete dental coverage, including oral and maxillofacial surgery.
Some complex oral surgery may also be handled differently from routine dental care. Your dentist or oral surgeon can check whether the procedure should be billed through your dental coverage, health plan, or another Medicaid benefit.
Before scheduling surgery, ask the provider to confirm that both the provider and the procedure are covered.
How Do I Get Approval for Wisdom Teeth Removal?
Start by seeing a dentist or oral surgeon who accepts your Medicaid coverage. They can examine the wisdom tooth, take any needed X-rays, and decide what treatment is medically needed.
The process may include:
Get an exam. Tell the dentist about pain, swelling, infection, or other symptoms.
Get X-rays if needed. These can show whether the wisdom tooth is impacted or affecting nearby teeth.
Ask the provider to check your benefits. Coverage can depend on your age and Medicaid plan.
Complete prior authorization if required. Your provider usually sends the needed records to the plan.
Ask about your appeal rights if coverage is denied. Louisiana Medicaid members have the right to appeal certain coverage decisions.
Do not assume you have to pay for the procedure just because a dental office says Medicaid may not cover it. Ask the office to check your specific plan first.
Can Nest Health Help With Dental Concerns Like Wisdom Teeth?
Nest Health does not remove wisdom teeth or provide dental services, but we can help with health concerns that may come with a dental problem. For example, a Nest provider can evaluate symptoms such as pain or swelling and help you understand what type of follow-up care you may need.
For eligible Medicaid families in the New Orleans and Baton Rouge areas, Nest provides primary care at home and virtually and can help connect families with other healthcare and community resources.
Learn more about Nest Health for Louisiana families.
Dealing with tooth pain or another health concern? Nest Health provides in-home and virtual primary care for eligible Medicaid families and can help you figure out the right next step, including connecting you with dental care when needed. Services may be available at no additional cost through your Medicaid health plan. Call 866-222-NEST (6378) to see if your family is eligible.
