Star Medicaid does provide dental coverage for eligible individuals. The program covers a wide range of dental services, including preventive care, such as cleanings and exams, as well as more complex procedures, such as fillings, root canals, and dentures. Coverage also includes orthodontics for children and adults in certain cases. To be eligible for Star Medicaid dental coverage, individuals must meet certain income and asset requirements and must be enrolled in the Star Medicaid program. The scope and extent of dental coverage may vary based on the specific plan and state regulations. It is recommended to contact the local Medicaid office or visit the official Medicaid website for further assistance and information regarding dental coverage availability and specific services covered under the Star Medicaid program.
Eligibility Criteria for Star Medicaid Dental Coverage
Star Medicaid is a health insurance program that provides comprehensive medical and dental coverage to eligible individuals and families in Texas. The program is jointly funded by the federal government and the state of Texas.
To be eligible for Star Medicaid dental coverage, you must meet certain criteria. The following are the general eligibility criteria:
- Be a Texas resident.
- Be a U.S. citizen or a qualified non-citizen.
- Meet the income and asset limits set by Star Medicaid.
- Be eligible for one of the following Star Medicaid programs:
- Children’s Medicaid
- Star Kids
- STAR+PLUS
- STAR Health
- Family Planning
In addition to the general eligibility criteria, there are specific eligibility criteria for children and pregnant women. Children must be under the age of 21 or 19 if they are pregnant.
Pregnant women are eligible for Star Medicaid dental coverage if they meet the following criteria:
- Be a Texas resident.
- Be a U.S. citizen or a qualified non-citizen.
- Meet the income and asset limits set by Star Medicaid.
- Be pregnant.
Individuals who are eligible for Star Medicaid dental coverage will receive a Star Medicaid ID card. This card will allow them to access dental care services from any dentist who accepts Star Medicaid.
The following table provides a summary of the eligibility criteria for Star Medicaid dental coverage:
| Category | Age | Income Limit | Asset Limit |
|---|---|---|---|
| Children | Under 21 | 138% of the federal poverty level | $2,000 |
| Pregnant Women | Any age | 138% of the federal poverty level | $2,000 |
| Adults | 19 or older | 138% of the federal poverty level | $2,000 |
Scope of Dental Services Covered by Star Medicaid
Star Medicaid is a health insurance program that provides comprehensive medical and dental coverage to eligible individuals and families in the state of Texas. Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families. The program is administered by the state through managed care organizations (MCOs). Dental services covered under STAR Medicaid vary depending on the MCO, but generally include the following:
- Preventive services: Checkups, cleanings, fluoride treatments, and sealants
- Restorative services: Fillings, crowns, bridges, and dentures
- Endodontic services: Root canals and other procedures to treat the pulp of the tooth
- Periodontic services: Treatment of gum disease, including scaling and root planing
- Oral surgery services: Extractions, implants, and other surgical procedures
In addition to these basic services, some MCOs also offer additional dental services, such as:
- Orthodontic services: Braces and other devices to correct misaligned teeth
- Cosmetic dentistry services: Teeth whitening and other procedures to improve the appearance of the teeth
To find out what dental services are covered under your Star Medicaid plan, you should contact your MCO.
| Service | Description |
|---|---|
| Preventive Services | Checkups, cleanings, fluoride treatments, and sealants |
| Restorative Services | Fillings, crowns, bridges, and dentures |
| Endodontic Services | Root canals and other procedures to treat the pulp of the tooth |
| Periodontic Services | Treatment of gum disease, including scaling and root planing |
| Oral Surgery Services | Extractions, implants, and other surgical procedures |
| Orthodontic Services | Braces and other devices to correct misaligned teeth |
| Cosmetic Dentistry Services | Teeth whitening and other procedures to improve the appearance of the teeth |
Does Star Medicaid Cover Dental: Limitations and Exclusions
Generally, Star Medicaid provides coverage for dental services for eligible beneficiaries, but there are certain limitations and exclusions to this coverage. While basic dental services may be covered, the extent of coverage can vary depending on the specific circumstances of the individual case. Here are some key limitations and exclusions to be aware of:
Age Restrictions:
- Children: Dental coverage under Star Medicaid is generally available for children from birth to 20 years of age.
- Adults: Dental coverage for adults may be limited or not available altogether in certain states.
Covered Services:
- Routine Care: Preventive dental care, such as cleanings, exams, and fluoride treatments, is typically covered, but frequency limits may apply.
- Restorative Care: Treatment for cavities, crowns, and fillings may be covered, subject to certain limitations.
- Emergency Care: Services to address immediate dental pain or infection may be covered, but the definition of emergency care can vary.
- Orthodontics: Orthodontic treatment, such as braces, may not be covered or may have strict eligibility criteria.
- Cosmetic Dentistry: Services that are primarily cosmetic in nature, such as teeth whitening, are generally not covered.
Provider Network:
- Medicaid-Enrolled Dentists: Star Medicaid typically has a network of enrolled dentists who accept Medicaid patients. The availability of dentists in the network and their locations may vary.
- Out-of-Network Care: Coverage for dental services provided by out-of-network dentists may be limited or unavailable.
Prior Authorization:
- Certain Procedures: Some dental procedures may require prior authorization from Star Medicaid before the service is provided.
- Approval Process: The prior authorization process can take time, and reimbursement may be denied if the authorization is not obtained.
Table: Star Medicaid Dental Coverage Summary
| Age Group | Routine Care | Restorative Care | Emergency Care | Orthodontics | Cosmetic Dentistry | Provider Network | Prior Authorization |
|---|---|---|---|---|---|---|---|
| Children (0-20 years) | Covered | Covered | Covered | May be limited | Not covered | Medicaid-Enrolled Dentists | May be required |
| Adults (21+) | May be limited or not covered | May be limited or not covered | May be limited | Not covered | Not covered | Medicaid-Enrolled Dentists | May be required |
Additional Information:
To find out more about Star Medicaid dental coverage in your specific state, you can:
- Contact Your State Medicaid Office: Reach out to your local Medicaid office for detailed information about available dental coverage and eligibility requirements.
- Check the Star Medicaid Website: Many states have dedicated sections on their Medicaid websites that provide information about dental coverage and a list of enrolled dentists.
- Talk to Your Dentist: If you have a dentist, they can help you understand your coverage options and guide you through the process of obtaining necessary dental services.
Remember, limitations and exclusions in Star Medicaid dental coverage can vary from state to state. It’s essential to check with your state’s Medicaid office or consult with a knowledgeable representative for accurate and up-to-date information regarding your specific situation.
Eligibility for Star Medicaid Dental Coverage
To be eligible for Star Medicaid dental coverage, you must meet certain income and residency requirements. You must be a resident of the state of Texas and meet the financial eligibility criteria set by the state.
Income Requirements for Star Medicaid Dental Coverage
- For individuals, your annual income must be at or below 138% of the federal poverty level.
- For families, your annual income must be at or below 200% of the federal poverty level.
Residency Requirements for Star Medicaid Dental Coverage
- You must be a legal resident of the state of Texas.
- You must provide proof of residency, such as a utility bill or lease agreement.
How to Apply for Star Medicaid Dental Coverage
You can apply for Star Medicaid dental coverage online, by mail, or in person at your local Medicaid office. You will need to provide the following information:
- Your name, date of birth, and Social Security number
- Your address and phone number
- Your income and asset information
- Proof of residency
Services Covered by Star Medicaid Dental Coverage
Star Medicaid dental coverage provides a range of services, including:
- Preventive services, such as cleanings, exams, and fluoride treatments
- Restorative services, such as fillings, crowns, and root canals
- Oral surgery services, such as extractions and wisdom teeth removal
- Orthodontic services, such as braces and retainers
| Service | Coverage |
|---|---|
| Cleanings | Every 6 months |
| Exams | Every year |
| Fluoride treatments | Every 6 months for children under 16 |
| Fillings | As needed |
| Crowns | As needed |
| Root canals | As needed |
| Extractions | As needed |
| Wisdom teeth removal | As needed |
| Braces | For children and adults with severe orthodontic problems |
| Retainers | After braces are removed |
Contact Information for Star Medicaid Dental Coverage
If you have questions about Star Medicaid dental coverage, you can contact the Texas Health and Human Services Commission:
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