MassHealth Dental Program
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What is the MassHealth Dental Program?
The MassHealth Dental Program provides dental benefits for MassHealth members. Dental benefits include checkups, cleanings, fillings, extractions, braces, dentures, and other necessary dental services. Members under age 21 get more dental benefits than adults age 21 or older.
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.
What dental benefits will I get?
MassHealth dental benefits 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)
- fillings
- extractions
- emergency dental care
Members under 21 get these additional benefits:
- fluoride treatments
- sealants
- custom-fitted mouth guards for sports
Other dental services are covered, but require prior authorization. These include:
- periodontal scaling and root planing
- surgical treatment of gum disease
- crowns, posts, and cores
- root canals
- dentures
- removal of impacted teeth
- most oral surgery
- orthodontics (braces) - treatment must be started by age 18 ½
- hospital procedures (outpatient or inpatient)
- custom dental night guards to prevent tooth grinding
- additional fees for treatment of mentally ill or disabled patients
- other services listed under prior authorization in the MassHealth Dental Manual
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 include:
- cosmetic dentistry
- dental implants
- treatment of temporomandibular joint (TMJ) disease
- oral hygiene devices and mouth rinses
- habit-breaking appliances
- experimental 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.
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.
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:
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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.
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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.
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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:
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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.
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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.
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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.
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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.
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:
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:
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.
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MassHealth Dental Manual
Comprehensive information about MassHealth Dental, including regulations, billing instructions, and service codes for providers.
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MassHealth Dental Portals
Access to information about the MassHealth Dental Program, such as benefits, forms, and contact information. Includes:
MassHealth Dental Program section last updated on 9/28/09
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