It’s no secret that good dental health is a critical piece of overall health and well-being. Yet, millions of Americans lack access to dental care due to income or other barriers. Private dental insurance often poses its own kind of obstacles for patients seeking care, but for those who rely on Medicaid for healthcare coverage, the situation is even more challenging.
To facilitate the best patient outcomes and protect practice revenue, it’s important that dental practices fully understand the evolving Medicaid landscape.
Does Medicaid cover dental care?
Medicaid helps cover the cost of medical services for people at a low income threshold, as well as individuals with certain conditions or disabilities. Because it is a joint program between the federal and state governments, all programs must follow general guidelines. However, exact program details and benefits vary from state to state — especially when it comes to dental care.
Traditionally, state Medicaid programs are required to cover minimal dental care for individuals under the age of 21. They have not been required to cover dental care for people over the age of 21. Although emergency dental services are offered by most states for adults, comprehensive dental care is provided by less than half of them, with no mandatory standards for coverage. For example, Texas provides no adult dental coverage at all.
The COVID-19 Public Health Emergency and dental coverage under Medicaid
The COVID-19 pandemic further complicated access to dental care. Consistent access to healthcare services was disrupted for many patients, including routine dental procedures. To address this, a national Public Health Emergency (PHE) was declared in March 2020, which allowed for expanded access to Medicaid — and, by extension, basic dental coverage. Some states even implemented new or expanded coverage. The emergency declarations allowed more individuals to access the program and prohibited states from disenrolling anyone.
Now, as the PHE is set to expire on May 11, 2023, states will begin the process of reviewing eligibility and disenrolling individuals who are no longer eligible for coverage. It’s estimated that over 14 million people currently enrolled in Medicaid will lose dental coverage. Individuals seeking dental care will be forced to explore other financial options or even consider forgoing services. Dental practices will have to find new ways to encourage patients to come in for their routine care and increase case acceptance.
Dental membership plans: An accessible option for dental care
Dental membership plans can play a key role in filling the gaps caused by shrinking benefits and disappearing Medicaid coverage. Under a membership plan, patients pay a reasonable fee to unlock discounts on a full menu of services at their dental office. This provides them affordable access to routine dental care, without the sticker shock of paying cash at full price or the hassle and complexity of the private dental insurance market.
On top of providing greater access to care, there are countless benefits for dental practices, too. Dental membership plans help practices build recurring revenue that is independent of fluctuations in Medicaid or decreasing reimbursement from private insurance. They can also increase case acceptance and help build a loyal customer base. Plus, because patients pay practices directly for any services that they receive, there’s no need to file claims and then wait on delayed reimbursement. Overall, dental membership plans offer a win-win solution for both patients and dental practices.
A partner for building your dental membership plan
As you explore ways to protect your business from the changing reimbursement landscape, Membersy is here to help. By offering a dental membership plan, you can improve access to dental care, reduce administrative costs, and increase patient loyalty.
We’ll help you create a dental membership plan that provides your patients with accessible, affordable care, while allowing you to take control of your revenue. With Membersy's support, you can focus on providing quality care to your patients while we take care of the rest. Contact us today to learn more about how we can help you build a successful dental membership plan.