Medicaid Dentist in Roanoke, VA: What Medicaid Covers

Mill Mountain Dentistry By Opulent Dental accepts Virginia Medicaid. If you have Medicaid or FAMIS coverage, your dental benefits run through Cardinal Care Smiles, Virginia's Medicaid dental program, which covers exams, X-rays, cleanings, fillings, root canals, gum treatment, extractions, and dentures for adults, plus comprehensive care for children. Here is what that coverage includes and how to use it at our Roanoke office.

Many people do not realize that Virginia Medicaid now includes dental care for adults, not just children. If you have put off a checkup or a painful tooth because you were unsure what Medicaid would pay for, this guide walks you through the basics.

What Is Cardinal Care Smiles?

Cardinal Care Smiles is the dental program for Virginia Medicaid and FAMIS members. It is managed by DentaQuest on behalf of the Virginia Department of Medical Assistance Services (DMAS). Children have long had dental coverage under Virginia Medicaid, and comprehensive dental benefits for adults age 21 and older began on July 1, 2021.

You do not sign up for Cardinal Care Smiles separately. If you are enrolled in Medicaid or FAMIS, your dental benefits are included, and your member ID card is what our front desk uses to check your coverage.

What Does Virginia Medicaid Cover for Adults?

According to DMAS, covered dental services for adult Medicaid members include:

• Diagnostic care: exams and X-rays
• Preventive care: professional cleanings
• Restorative care: fillings for cavities and small breaks
• Root canals: treatment to save a tooth with an infected or inflamed nerve
• Gum-related treatment: care for gum disease
• Dentures: complete and partial dentures to replace missing teeth
• Extractions and other oral surgery: removing teeth that cannot be saved

Fillings are one of the most common covered treatments. If you want to know what fillings involve and what they typically cost with other coverage, see our guide to dental filling cost in Roanoke.

What Medicaid Does Not Cover for Adults

Medicaid pays for care that is medically necessary, so some treatments fall outside adult coverage. Braces are not covered for adult members, and DMAS notes that bridges are not covered either. Cosmetic treatments, such as teeth whitening or veneers placed to change how teeth look, are generally not covered. Some covered services also need approval from DentaQuest before treatment begins, and coverage can include frequency limits, such as how often cleanings or new dentures are allowed.

The details for your specific situation come from DentaQuest. When you visit, we check your eligibility and explain which parts of a recommended treatment plan Medicaid is expected to cover before any work starts.

Why Adults With Medicaid Should Not Delay Dental Care

Many adults who gained Medicaid dental coverage in 2021 had gone years without a checkup. Waiting rarely makes a dental problem cheaper or simpler. A cavity that needs a small filling today can reach the nerve within months, and a tooth that could have been saved with a root canal may end up needing to be removed. Gum disease also tends to progress quietly, with bleeding and bad breath as the main early signs. Starting with a covered exam and cleaning gives you a clear picture of what needs attention now and what can wait.

Medicaid Dental Coverage for Children and Teens

Cardinal Care Smiles offers comprehensive dental services to children through age 20. That includes checkups, cleanings, X-rays, fluoride, sealants, fillings, and other medically necessary care. Orthodontic treatment for children may be covered when it is medically necessary and approved in advance, while braces for purely cosmetic reasons are not.

A child's first dental visit is recommended by the first birthday, and regular checkups from then on help catch cavities while they are small. Our office sees children and teens alongside their parents, so families can keep everyone's care in one place. Learn more about our children's dentistry.

Dental Coverage During Pregnancy

Cardinal Care Smiles also covers pregnant members enrolled in Medicaid or FAMIS MOMS, including those age 21 and older. Pregnancy can make gums more prone to swelling and bleeding, and routine dental care is considered safe during pregnancy. If you are expecting, let us know when you book so we can plan your visit around your stage of pregnancy.

How to Use Your Medicaid Dental Benefits at Our Roanoke Office

1. Call to schedule. Tell our front desk you have Virginia Medicaid or FAMIS so we can check your eligibility before the visit.
2. Bring your cards. Bring your Medicaid member ID card and a photo ID to your appointment.
3. Get an exam and a plan. Your first visit usually includes an exam and X-rays. We explain what we find and which treatment is covered.
4. Ask about approvals. If a treatment needs approval from DentaQuest first, we will let you know before scheduling it.
5. Keep up with checkups. Covered cleanings and exams help prevent the larger problems that are harder to treat later.

Missing teeth are one of the most common reasons adults look for a Medicaid dentist. Because dentures are a covered adult service, many patients start there. Our guide to dentures in Roanoke explains complete and partial options and what to expect.

Tips for Getting the Most From Your Medicaid Dental Benefits

• Book cleanings on schedule. Covered preventive visits are the easiest way to avoid larger treatment.
• Ask about limits. Some services are allowed only so often, so ask before replacing a recent filling or denture.
• Keep your Medicaid renewal current. Update your address and respond to renewal notices so your coverage does not lapse between visits.
• Bring a medication list. Some medicines affect your gums or dry out your mouth, which changes how we plan care.
• Ask for your plan in writing. A written treatment plan shows what is covered and what, if anything, is not.

Getting to Our Office

Our office is at 5000 Brambleton Avenue in Roanoke, in the Cave Spring area near Electric Road (VA-419). We are open Monday through Thursday from 7:30 AM to 5:30 PM and Friday from 7:30 AM to 2:30 PM. Medicaid members who need help getting to covered appointments can call the number on their member card to ask about non-emergency transportation.

If Medicaid Does Not Cover Part of Your Treatment

When a treatment you want is not covered, such as a bridge or cosmetic work, we explain the cost before anything is scheduled. Our office accepts CareCredit, offers in-house payment plans, and has a VIP Membership savings plan. You can read more about insurance and financing options in Roanoke, including how each option works.

Frequently Asked Questions

Do you accept Virginia Medicaid?

Yes. Mill Mountain Dentistry By Opulent Dental accepts Virginia Medicaid and FAMIS dental coverage through Cardinal Care Smiles, along with most major dental insurance plans.

Does Virginia Medicaid cover dental care for adults?

Yes. Since July 1, 2021, adult Medicaid members have had dental coverage that includes exams, X-rays, cleanings, fillings, root canals, gum treatment, extractions, and dentures.

Does Medicaid pay for dentures in Virginia?

Dentures are a covered service for adult members. Frequency limits and approval rules can apply, so we confirm your benefits before starting.

Does Medicaid cover braces?

Not for adults. For children and teens through age 20, orthodontic treatment may be covered when it is medically necessary and approved in advance.

How can I find out exactly what my plan covers?

Call DentaQuest at 1-888-912-3456, or contact our office and we will check your eligibility and benefits before your visit.

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