Dental services are one of the most needed and most expensive costs facing many older adults. Older adults often find themselves in pain, unable to chew, and losing weight as a result of poor dental care.
The State legislature expanded coverage for dental care for seniors during the last session. As of July 1, 2014, any adult 18 years of age and over who receives Medicaid is eligible for $1000 per year of coverage for dental care. Medicaid recipients can receive regular check-ups, x-rays, cleanings, extractions, and fillings. In addition, some or all of the benefit can also be used to pay all or a part of such things as root canals and crowns.
To participate, Medicaid recipients must see a dentist who accepts Medicaid. Although the reimbursement is lower than private pay and insurance, the number of dentists who are willing to accept Medicaid is growing.
In addition, Medicaid recipients can receive an additional $1450 every seven years to cover the cost of partial and full dentures. This denture benefit is particularly beneficial to low income seniors who often have not seen a dentist for more than 20 or 30 years and who have substantial tooth decay.
Another benefit to Medicaid recipients is the opportunity to pay privately for additional services beyond the $1000 cap at Medicaid rates. Thus if the Medicaid recipient needs two crowns, the dentist is required to extend the reduced Medicaid rate for those procedures that exceed the Medicaid cap of $1000, another way for older adults to receive dental care.
Medicaid beneficiaries who live in their own home, an assisted living or a nursing home can have dental care paid by Medicaid. A number of mobile dental labs are offering services at low income senior buildings, as well as assisted living residences and nursing homes.
Another dental program approved by the legislature is the Low Income Senior Dental Program (formerly known as the OAP Dental Program). This program is administered through grants made by the Colorado Department of Public Health and Environment to selected private dentists and dental clinics.
Individuals must be age 60 and over and received Medicare. To qualify for the Low Income Dental Program for Seniors, older adults must also be receiving the Medicare Savings Program. If you qualify, you can visit any participating dentist or call 303-333-3482 for a list.
Individuals who are not receiving the Medicare Savings Program, but who think they may qualify if their income is less than $1333 per month from all sources and who have less than $8,660 in assets excluding a house, car, irrevocable burial policy, and a term life insurance policy can call 1-855-293-6911 for counseling and assistance. Counselors are on hand to help you apply for the Medicare Savings Program.
The legislature is hopeful that the increased funding for dental care will improve overall health of Medicaid beneficiaries and other low income seniors.