Does Utah Medicaid cover dental and vision care?
Utah Medicaid provides coverage for both dental and vision care, but the extent of coverage varies depending on whether the recipient is an adult or a child. While children receive comprehensive dental and vision services, coverage for adults is more limited. Here’s a detailed overview of what’s covered for both groups under Utah Medicaid.
1. Dental Care Coverage Under Utah Medicaid
A. Dental Coverage for Children
Children enrolled in Medicaid or CHIP (Children’s Health Insurance Program) receive full dental coverage to ensure their oral health is maintained. These services include:
Routine dental exams: Covered every six months.
Cleanings: Covered twice per year.
Fluoride treatments: Provided to prevent tooth decay.
Dental X-rays: Diagnostic X-rays to detect cavities or other issues.
Fillings and sealants: Treatment for cavities and preventative care.
Extractions: Removal of decayed or problematic teeth when necessary.
Orthodontic services: In some cases, children with severe dental conditions may be eligible for orthodontic care, such as braces.
B. Dental Coverage for Adults
Dental coverage for adults under Utah Medicaid is more limited, but certain groups do have access to dental services:
Basic dental services: Adults on Traditional Medicaid (Blind/Disabled or Aged) receive limited dental care, including cleanings, exams, and extractions.
Emergency dental services: All adults are covered for emergency dental care, such as treating infections, relieving pain, and tooth extractions due to severe conditions.
Full dental benefits for adults with disabilities: Adults on Medicaid under the Medicaid Work Incentive (MWI) Program and Medicaid for the Blind or Disabled receive expanded dental services.
2. Vision Care Coverage Under Utah Medicaid
A. Vision Coverage for Children
Children under Utah Medicaid or CHIP are eligible for comprehensive vision care, which includes:
Routine eye exams: Covered once per year to detect vision issues.
Prescription eyeglasses: Medicaid covers the cost of eyeglasses if prescribed during an eye exam, and children can get new lenses or frames as needed.
Vision screenings: Routine vision screenings are provided during well-child visits to detect potential vision problems early.
B. Vision Coverage for Adults
For adults, vision care is generally limited but may include:
Eye exams: Basic eye exams may be covered for adults under certain Medicaid programs, especially for those with a medical condition affecting their vision.
Glasses or contacts: Coverage for eyeglasses or contact lenses is usually not included for adults, except for certain medical conditions, such as after cataract surgery.
3. How to Access Dental and Vision Services
To access dental and vision services through Utah Medicaid:
For children: Most Medicaid-enrolled children will automatically receive coverage for dental and vision services. Ensure your child sees a Medicaid-approved provider.
For adults: If you are unsure whether you qualify for dental or vision coverage, check with Utah Medicaid or your Medicaid plan to confirm what services you are eligible for.
4. Finding Medicaid-Approved Providers
To find Medicaid-approved dental or vision providers in Utah:
Use the Utah Medicaid provider directory: This will help you locate a dentist or eye care professional who accepts Medicaid.
Contact your Medicaid health plan: They can assist you in finding in-network providers.
Key Takeaways:
Children enrolled in Medicaid or CHIP receive comprehensive dental and vision care, including routine exams, glasses, and necessary treatments.
Adults receive limited dental coverage under Utah Medicaid, with emergency dental care covered for all, and basic dental care available for certain groups.
Vision care for adults is generally limited to basic eye exams, with some exceptions for medical conditions.
For assistance understanding your Medicaid dental and vision benefits or finding a provider, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
