MassHealth Dental Program

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What is the MassHealth Dental Program?

How do I contact MassHealth Dental?

Am I eligible?

What dental benefits will I get?

What dental services are not covered?

How do I apply?

How do I use my benefits?

How do I file a complaint or appeal?

Useful links

Important changes in MassHealth adult dental coverage went into effect July 1, 2010. Emergency and preventive treatment for adults (such as x-rays, cleanings, and extractions) are still covered by MassHealth, but restorative services for adults are not. Restorative services include fillings, root canals, crowns, dentures, and periodontic treatment. MassHealth dental benefits for children (under 21) and for DDS clients did not change.

What is the MassHealth Dental Program?

The MassHealth Dental Program provides dental benefits for MassHealth members. Members under age 21 get more dental benefits than adults age 21 or older.

MassHealth dental benefits for adults include diagnostic and preventive services (such as checkups, cleanings, and x-rays), extractions, and emergency treatment. As of July 1, 2010, MassHealth Dental does not cover fillings, crowns, root canals, dentures, and other restorative services for most members age 21 or older.

Dental benefits for children (under age 21) also include coverage for restorative services (such as fillings), braces, root canals, and other necessary dental services.

The regulations for MassHealth dental benefits are outlined in the MassHealth Dental Manual 130 CMR 420 and the MassHealth All Provider Manual 130 CMR 450.105 (requires Adobe Reader).

The MassHealth Dental Program is managed by Dental Services of Massachusetts (DSM) and Doral Dental USA.

How do I contact MassHealth Dental?

To contact MassHealth Dental, call or write:

MassHealth Dental Program
12121 N. Corporate Parkway
Mequon, WI 53092
 
Telephone: 1-800-207-5019
TTY: 1-800-466-7566
Fax: 1-800-207-4795
Web site: MassHealth Dental for Members; MassHealth Dental for Providers
 
Customer Service hours: 8 AM to 6 PM, Monday through Friday
Translators are available.

If you have general questions, you can send an e-mail to member@masshealth-dental.net or use the MassHealth Dental Send E-mail web form. Do not include your full name, MassHealth ID number, or any other confidential information in your e-mail. If you have specific questions about your dental benefits, call Dental Customer Service instead.

Am I eligible?

MassHealth members with the following coverage types are eligible for dental benefits:

• Standard
• CommonHealth
• Basic
• Essential
• Family Assistance Direct Coverage
• Family Assistance Premium Assistance: children under age 19 only
• Prenatal
• Limited (for emergencies only)

If you have any questions about your eligibility, you should call MassHealth Dental Customer Service at 1-800-207-5019 (TTY: 1-800-466-7566). Hours are 8 AM to 6 PM, Monday through Friday.

 Starting July 1, 2010, adult MassHealth members age 21 or older, except DDS clients, are only eligible for preventive, diagnostic, and emergency dental benefits.

What dental benefits will I get?

MassHealth dental benefits for adults (21 or older) include:

• complete checkup (once with each new dental provider)
• regular checkups (twice per 12-month period)
• cleanings (twice per 12-month period)
• radiographs (X-rays)
• extractions 
• emergency dental care 
• certain types of oral surgery (such as biopsies) 

Members under 21 get these additional benefits:

• fluoride treatments
• sealants
• fillings
• root canals
• crowns, posts, and cores
• most oral surgery
• orthodontics (braces) - treatment must be started by age 21 
• surgical treatment of gum disease
• custom-fitted mouth guards for sports
• hospital procedures (outpatient or inpatient)
• other services listed in the MassHealth Dental Manual

Some of these dental services require prior authorization.

If MassHealth will not pay for a dental service that you believe is covered, you can appeal the decision. See How do I file a complaint or appeal?

What dental services are not covered?

Dental services that are not covered for adults or children include:

• cosmetic dentistry
• dental implants
• treatment of temporomandibular joint (TMJ) disease
• oral hygiene devices and mouth rinses
• habit-breaking appliances
• experimental procedures
• substitutions or modifications of covered procedures
• any other service not listed in the MassHealth Dental Manual

MassHealth sometimes pays for noncovered services for members under age 21. The services must be medically necessary, and the dental provider must request prior authorization. If MassHealth approves, the services will be covered.

 As of July 1, 2010, adults age 21 and older, except DDS clients, are not covered for fillings, root canals, crowns, periodontal services (deep scaling), or dentures. Adult MassHealth members may be able to get these dental services at community and hospital-based health centers through the Health Safety Net.

MassHealth will not pay for noncovered services for members age 21 or older.

How do I apply?

To get MassHealth dental benefits, you must be an eligible member of MassHealth. If you are not a member, you must apply for MassHealth. For information on how to apply, see MassHealth: How do I apply? MassHealth will pay for dental services only if you are an eligible MassHealth member on the date of service.

If you are already an eligible member of MassHealth, you do not have to apply separately for dental benefits. To get dental services, call a MassHealth dental provider to set up an appointment. See How do I use my benefits? for more information.

 If you are an adult MassHealth member who needs restorative dental services after July 1, 2010, you should apply for the Health Safety Net. The Health Safety Net covers restorative dental services such as fillings, crowns, and dentures if they are provided at community or hospital-based health centers.  For a list of health centers with dental programs, see Massachusetts Community Health Center Dental Program Directory on the Department of Public Health web site.

How do I use my benefits?

MassHealth will pay for your dental services only if you go to a dental provider who accepts MassHealth. MassHealth dental providers include private practice dentists, orthodontists, and oral surgeons; dental clinics; community health center dental services; and dental schools.

To find a MassHealth dentist:

• You can use the Find a Provider search tool on the MassHealth Dental web site to find a MassHealth dentist or specialist in your area. Click the "Accepting New Patients" box before you search if you are looking for a new dentist. Dentists sometimes limit the number of MassHealth patients they see. Some MassHealth dentists are not accepting new patients.

• You can also call MassHealth Dental Customer Service at 1-800-207-5019 (TTY: 1-800-466-7566) from 8 AM to 6 PM, Monday through Friday. Customer Service will help you find a dentist and help you make an appointment.

• A complete list of MassHealth dental providers is on the MassHealth Dental web site: MassHealth Dental Provider Directory.

Here are some things to remember when you use your dental benefits:

• If you already have a dentist, you should check to see if your dentist accepts MassHealth. If your dentist does not accept MassHealth, you must switch to a MassHealth dentist to get dental benefits.

• If you are eligible for MassHealth transportation benefits, Customer Service will help you get a ride to and from your dental appointment. See MassHealth Transportation Services for more information about MassHealth transportation benefits.

• Make sure you bring your MassHealth card with you when you go to your dental appointment. The dental office must check to make sure you are a MassHealth member on the date of your appointment.

• If you cannot keep an appointment, be sure to call ahead to cancel and set up a new appointment. If you miss too many appointments, your dentist may refuse to treat you.

• If you are an adult MassHealth member and you need fillings, dentures, or other restorative dental treatments not covered by MassHealth after July 1, 2010, you may be able to get these services at community or hospital-based health centers through the Health Safety Net. For a list of health centers with dental programs, see Massachusetts Community Health Center Dental Program Directory on the Department of Public Health web site.

How do I file a complaint or appeal?

Filing a complaint:

You can file a complaint if you are not happy with the way you were treated or the dental services you received. MassHealth Dental will answer your complaint within 10 working days of the date they receive it. There are two ways to get a complaint form:

• You can download a complaint form from the MassHealth Dental web site:

  MassHealth Member Dental Complaint Form (English)
  MassHealth Member Dental Complaint Form (Spanish)
  (require Adobe Reader)

  Fill out the form and send it to the address printed on the form.

• You can call Dental Customer Service at 1-800-207-5019 (TTY: 1-800-466-7566). Customer Service will send a form to you, or will fill it out for you over the phone.

Filing an appeal:

You can file an appeal if you are denied dental benefits or your dental benefits are reduced. You must file your appeal within 30 calendar days of your denial notice. There are two ways to get an appeal form:

• You can download an appeal form from the MassHealth Dental web site:

  Fair Hearing Request Form (English)
  Fair Hearing Request Form (Spanish)
  (require Adobe Reader)

  Fill out the form and send it to the address printed on the form.

• You can call Dental Customer Service at 1-800-207-5019 (TTY: 1-800-466-7566). Customer Service will send a form to you, or will help you file your appeal.

Useful links

These links are external links to web sites that are not part of MassResources.org. When you click on these links, you will leave our site. Click "Back" on your browser to return.

1. MassHealth Dental Manual
   Comprehensive information about MassHealth Dental, including regulations, billing instructions, and service codes for providers.

2. MassHealth Dental Portals
   Access to information about the MassHealth Dental Program, such as benefits, forms, and contact information. Includes:

   • MassHealth Dental Information for Members
   • MassHealth Dental for Providers and Partners

3. MassHealth Provider Information
   News and updates about MassHealth dental coverage, from the Massachusetts Dental Society.

MassHealth Dental Program section last updated on 7/13/10