South Dakota Medicaid Dental Care for Adults · South Dakota Medicaid Dental Care for Adults...

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South Dakota Medicaid Dental Care for Adults Covered Services • Two exams per coverage year • Two cleanings per coverage year • Silver Diamine Fluoride • Fillings • X-rays • Removal of teeth • Permanent crowns on front teeth • Stainless steel crowns • Root canals on front teeth • Partial dentures and full dentures (no more than once every 5 years) Non-covered Services • Fluoride treatment • Permanent crowns on back teeth • Root canals on back teeth • Bridges (to fill a gap between teeth) • Tooth implants • Braces • Cosmetic procedures Coverage year is July 1 - June 30 For more information about your South Dakota Medicaid Dental Benefits contact 1-877-841-1478 or [email protected]

Transcript of South Dakota Medicaid Dental Care for Adults · South Dakota Medicaid Dental Care for Adults...

Page 1: South Dakota Medicaid Dental Care for Adults · South Dakota Medicaid Dental Care for Adults Covered Services coverage • Two exams per year coverage • Two cleanings per year •

South Dakota Medicaid Dental Care for AdultsCovered Services

• Two exams per coverage year • Two cleanings per coverage year • Silver Diamine Fluoride • Fillings • X-rays • Removal of teeth • Permanent crowns on front teeth • Stainless steel crowns • Root canals on front teeth • Partial dentures and full dentures (no more than once every 5 years)

Non-covered Services

• Fluoride treatment • Permanent crowns on back teeth • Root canals on back teeth • Bridges (to fill a gap between teeth) • Tooth implants • Braces • Cosmetic procedures

Coverage year is July 1 - June 30For more information about your South Dakota Medicaid Dental Benefits contact

1-877-841-1478 or [email protected]

Page 2: South Dakota Medicaid Dental Care for Adults · South Dakota Medicaid Dental Care for Adults Covered Services coverage • Two exams per year coverage • Two cleanings per year •

Adults are eligible for $1,000 worth of services per coverage year. Make sure to get two preventive exams and cleanings each coverage year. These exams and cleaning do not count towards the $1,000. Emergency services and dentures are also exempt from the $1,000 max. If you need more than a $1,000 of non-exempt services, you will be responsible for the cost of those services.

You are responsible for keeping your dental appointments. If you cannot keep your appointment, please call the dental office to let them know in advance. If you miss appointments your dentist may no longer let you be a patient.

Need help keeping an appointment? South Dakota Medicaid can assist. Call 1-877-841-1478.

If you are on the Medicaid pregnancy-only program, you are not eligible for routine dental coverage.

How It Works

If you need dentures, partials, crowns or other work that costs $500 or more, your dentist will have to get approval from Medicaid before starting the work.

You will need to pay $3 per procedure unless you are: ° Under age 21; ° Receiving hospice care; ° Residing in a nursing home or receiving home and community-based services; ° An American Indian who has ever received an item or service furnished by Indian Health Services (IHS); or ° In the Breast and Cervical Cancer program.

V10-2018

The Department of Social Services does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of actual or perceived race, color, religion, national origin, sex, age, gender identity, sexual orientation or disability in admission or access to, or treatment or employment in its programs, activities, or services. For more information about this policy or to file a Discrimination Complaint you may contact: Discrimination Coordinator, Director of DSS Division of Legal Services, 700 Governor’s Drive, Pierre, SD 57501, 605.773.3305. Español (Spanish) - ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1.800.305.9673 (TTY: 711). Deutsch (German) - ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1.800.305.9673 (TTY: 711).

Services must be medically neccessary. Medicaid does not cover cosmetic dental procedures.


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