MassHealth Insurance
MassHealth Dental Insurance Plans
Eligibility
MassHealth dental coverage is available to Massachusetts residents who meet specific income, residency, and citizenship or immigration requirements. Eligibility may vary based on age, medical needs, disability status, pregnancy, or enrollment in programs such as the Department of Developmental Services (DDS).
Our team can verify your eligibility in just a few minutes—simply bring your MassHealth ID when you arrive or provide your member information by phone.
Understanding Your Benefits
MassHealth dental benefits depend on your plan type and age. Children generally receive the most comprehensive coverage. Adults are covered for medically necessary dental services, and DDS members may qualify for expanded benefits. Certain procedures may require prior authorization before treatment can begin.
| Service category | Children under 21 (Standard / CommonHealth / Family Assistance / CarePlus) | Adults 21+ (Standard / CommonHealth / Family Assistance / CarePlus) | DDS adults (qualifying programs) | MassHealth Limited (emergency only) | CMSP (Children’s Medical Security Plan) |
| Exams, cleanings, fluoride | Covered (routine preventive care) | Covered (medically necessary) | Expanded preventive coverage in many cases | Covered only when part of an emergency visit | Covered up to annual plan maximum |
| X-rays and diagnostics | Covered | Covered (when medically necessary) | Covered, often at expanded levels | Covered when needed to treat an emergency | Covered, subject to CMSP limits |
| Sealants and preventive services | Covered on eligible teeth | Plan-dependent | Often covered similarly to children | Not typically covered | Covered, subject to CMSP limits |
| Fillings and basic restorative care | Covered | Covered (medically necessary) | Covered, often with expanded benefits | Covered only to relieve pain or infection | Covered for many basic needs until maximum is reached |
| Root canals | Covered (with some exceptions) | Plan-dependent | Often covered when medically necessary | Covered only when part of an emergency | Limited coverage; varies by CMSP plan tier |
| Crowns and major restorative | Covered when medically necessary | Covered when medically necessary | Often covered when medically necessary | Covered only if required to treat an emergency | Limited; varies by plan tier and annual maximum |
| Extractions and oral surgery | Covered | Covered | Covered | Covered when needed for pain, swelling, or infection | Covered when medically necessary within plan limits |
| Dentures and partials | Covered | Covered (medically necessary) | Often covered; enhanced benefits may apply | Covered only if part of emergency stabilization | Limited or not covered; depends on CMSP plan |
| Periodontal treatments | Covered when medically necessary | Covered on a plan-dependent basis (may require prior authorization) | Often covered when medically necessary | Only when needed in an emergency setting | Limited; varies by CMSP plan |
| Sedation / general anesthesia | Covered when medically necessary | Covered when medically necessary | Covered when medically necessary | Covered only if required to manage an emergency | Limited; varies by CMSP plan |
| Orthodontics | Covered only when medically necessary, with prior authorization | Generally not covered | May be covered when medically necessary with prior auth | Not covered | Not typically covered |
(Actual coverage depends on your specific MassHealth program, age, and medical needs. We will check your benefits for you.)
Services for Children (Under Age 21)
- Routine exams, cleanings, and fluoride treatments
- Sealants and preventive care
- X-rays and diagnostic imaging
- Fillings and crowns
- Root canals (with some exceptions)
- Tooth extractions and oral surgery
- Dentures, partials, and plates
- Space maintainers
- Sedation or general anesthesia (when medically necessary)
- Some orthodontic treatment (with prior authorization)
Services for Adults (21+)
Adult members may receive medically necessary services, including:
- Dental exams and cleanings
- X-rays and fluoride treatments
- Fillings and basic restorative care
- Root canals (plan-dependent
- Crowns (when medically necessary)
- Extractions and oral surgery
- Full and partial dentures
- Some periodontal treatments, which may require prior authorization
DDS (Department of Developmental Services) Patients
Adults enrolled in DDS programs may qualify for expanded dental benefits, often similar to the coverage provided to children. These benefits may include additional preventive, restorative, and medically necessary services. Our Fairhaven team works closely with DDS case managers to ensure coordinated and appropriate care.
Prior Authorization
Certain dental procedures require MassHealth approval before treatment, particularly orthodontics, periodontal therapy, major restorative procedures, and complex oral surgery. Our administrative team manages all prior authorization requests and keeps you informed throughout the process.
MassHealth Limited
MassHealth Limited provides emergency dental coverage only. Emergency services include care needed to relieve severe pain, reduce swelling, control infection, or address conditions that pose a health risk. If you are enrolled in MassHealth Limited, contact our Fairhaven office and we will review which emergency services may be covered.
Children’s Medical Security Plan (CMSP)
- Exams and cleanings
- Fluoride treatments
- Sealants
- Fillings
- Limited restorative procedures
Frequently Asked Questions
Does MassHealth cover crowns?
What dental services are covered for adults under MassHealth?
Adults may receive exams, cleanings, X-rays, fillings, extractions, dentures, crowns when medically necessary, root canals on certain teeth, and some periodontal services. Coverage depends on your specific plan.
Are children fully covered under MassHealth?
Yes. Children under 21 receive comprehensive benefits, including preventive and restorative care, fluoride treatments, sealants, X-rays, fillings, extractions, some periodontal procedures, and orthodontic services that are medically necessary (with prior authorization).
What is MassHealth Limited?
MassHealth Limited provides emergency-only dental coverage. This includes treatment to relieve pain, stop bleeding, or control infection. Routine dental services are not covered.
Will I have out-of-pocket costs?
Most medically necessary services are covered. Any services not included under MassHealth or optional upgrades may involve out-of-pocket costs. We always explain fees before treatment begins.
Do I need a referral from my primary care provider?
No. MassHealth does not require a referral for dental appointments.
What if I’m unsure whether I’m eligible?
Our team can verify eligibility quickly. Bring your MassHealth card or provide your member information by phone.
Are dentures covered under MassHealth?
Yes. MassHealth covers full and partial dentures when medically necessary. Replacement dentures may require clinical justification.
Is periodontal (gum) treatment covered?
Periodontal services such as scaling and root planing are covered when medically necessary. Coverage frequency depends on individual treatment needs.
Does MassHealth cover cosmetic dentistry or whitening?
No. Cosmetic procedures such as whitening, veneers, and elective cosmetic services are not covered.
Can adults receive sealants under MassHealth?
Sealants are typically covered for children and teens. Adult coverage varies and may not be included in all plans.
How often are cleanings covered?
Most members are covered for two preventive cleanings per year, with additional periodontal maintenance visits when needed.
Does MassHealth cover root canals on all teeth?
Coverage depends on the tooth. Front teeth and premolars are usually covered, while molars may require additional justification or may not be covered depending on the plan.
Our Service Area
Smiley Dental Fairhaven proudly serves patients from Fairhaven and surrounding South Coast communities, including New Bedford, Acushnet, Dartmouth, Mattapoisett, Marion, Rochester, Freetown, Fall River, and nearby Southeastern Massachusetts areas.
Call us today at 508-967-1000 to schedule your appointment.
