MassHealth Insurance
MassHealth Dental Insurance Plans
Looking for a MassHealth dentist in Fairhaven? Smiley Dental Fairhaven proudly accepts MassHealth dental coverage for children and adults. Our team makes it easy to understand your benefits, confirm your eligibility, and begin care without unnecessary stress. We handle the paperwork, including prior authorization, so you can focus on your health and your smile.
Eligible members can receive a wide range of dental services at our office. You can also view our full list of insurance plans we accept. We are accepting new patients, so call 508-967-1000 or request an appointment online to get started.
Why Fairhaven Families Choose Smiley Dental for MassHealth
Smiley Dental Fairhaven is part of a dental group with offices across Massachusetts, and our Fairhaven office at 17 Berdon Way welcomes patients of all ages from Fairhaven, New Bedford, and the surrounding South Coast. Our doctors bring training from schools such as Boston University, Harvard School of Dental Medicine, and New York University College of Dentistry. Our patient forms are available in English, Spanish, and Creole, and members of our team speak Spanish, Portuguese, and Cape Verdean Creole, among other languages. That means you can ask questions about your coverage in the language you are most comfortable with.
When you come in as a MassHealth member, you are treated by the same experienced clinicians as any other patient. Our front desk team checks your benefits before your visit, so you know what to expect.
Eligibility
MassHealth dental coverage is available to Massachusetts residents who meet income, residency, and citizenship or immigration requirements. Eligibility can also depend on age, medical needs, disability status, pregnancy, or enrollment in programs such as the Department of Developmental Services (DDS). Please note that adults age 21 and older who are not DDS clients are subject to a $1,750 annual dental maximum per benefit year beginning August 1, 2026. For official program details, you can visit the MassHealth website.
If you are not sure whether you qualify, 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
Your benefits depend on your plan type and your age. Children generally receive the most comprehensive coverage. Adults are covered for medically necessary dental services, subject to a $1,750 annual maximum per benefit year (effective August 1, 2026), and DDS members may qualify for expanded benefits with no annual maximum. Certain procedures need prior authorization before treatment can begin. Actual coverage depends on your MassHealth program, age, and medical needs, and we will check your benefits for you before your visit.
How It Works
- The benefit year runs July 1 to June 30. The first benefit year runs August 1, 2026 to June 30, 2027.
- The maximum resets to $1,750 each July 1. Unused amounts do not roll over.
- The amount counted is what MassHealth actually pays for covered services, not our billed charge.
- Your balance does not reset if your coverage changes or lapses during the benefit year.
- If you turn 21 during the benefit year, the maximum applies from your 21st birthday through June 30.
- Covered services and benefit limits have not changed. Services that were not covered before, such as night guards, are still not covered.
When You Reach the Maximum
- MassHealth stops paying for most covered services for the rest of that benefit year.
- Some services can still be covered, including limited dental exams, certain X-rays, denture repairs, tooth extractions, emergency pain relief, anesthesia for covered procedures, treatment of surgical complications, a first-ever complete denture after full-arch extractions, and continued orthodontic treatment for members who turn 21 during MassHealth-approved treatment.
- For a service that is no longer covered, we can charge you only if you choose to be a private-pay patient and sign a written agreement before the service is provided. We also offer flexible patient financing for treatment that is not covered.
- If the maximum is reached partway through a service, you can be billed only for the portion MassHealth did not pay, and only if you signed the agreement beforehand.
How we help: Before planning treatment, our Fairhaven team checks your remaining balance and explains what it means for your care and costs, so there are no surprises. Call 508-967-1000 to review your balance.
MassHealth dental coverage at a glance
| 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. Adult coverage is also subject to the $1,750 annual maximum described above. Some services, such as extractions, certain X-rays, denture repairs, and emergency pain relief, can still be covered after the maximum is reached. 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
Adult benefits are subject to a $1,750 annual maximum per benefit year (July 1 – June 30). Covered services and benefit limits have not changed. Our team will check your remaining balance before planning treatment.
DDS (Department of Developmental Services) Patients
Adults enrolled in Department of Developmental Services programs may qualify for expanded dental benefits, often similar to the coverage provided to children. These benefits may include extra preventive, restorative, and medically necessary services. The $1,750 adult annual maximum does not apply to adults who are DDS clients. Our Fairhaven team works closely with DDS case managers to coordinate appropriate care. Visit our MassHealth DDS Dentist page to learn more about the services we provide.
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 covers same day emergency care only. That includes care 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
Is there a yearly limit on MassHealth dental coverage for adults?
Yes. Starting August 1, 2026, MassHealth adult dental coverage has an annual maximum of $1,750 per benefit year for members age 21 and older who are not DDS clients. Members under 21 and adult DDS clients are not subject to the maximum.
When does the benefit year start and end? Does unused money roll over?
The benefit year runs July 1 through June 30. The first one is August 1, 2026 through June 30, 2027. The maximum resets to $1,750 every July 1, and unused amounts do not roll over.
What happens if I reach the $1,750 maximum?
MassHealth stops paying for most covered services for the rest of the benefit year. A few services, such as extractions, certain X-rays, denture repairs, anesthesia, and emergency pain relief, can still be covered. For other treatment, you can choose to continue as a private-pay patient by signing a written agreement before treatment, or wait until the benefit year resets on July 1.
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.
How can I find out how much of my maximum I've used?
Our team checks your remaining balance in MassHealth’s provider portal before planning treatment. Call 508-967-1000 and we’ll look it up for you. The balance only reflects claims that have finished processing, so it may change as claims are finalized.
What if I turn 21 during the year?
The maximum does not apply before your 21st birthday. It applies to services from your 21st birthday through June 30, then resets July 1.
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.
Does MassHealth cover crowns?
Crowns are covered when medically necessary, such as when a tooth is severely decayed or fractured. Prior authorization may be required in some cases. You can read more about crowns and bridges on our website.
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.
Do I need a referral from my primary care provider?
MassHealth Limited provides emergency-only dental coverage. This includes treatment to relieve pain, stop bleeding, or control infection. Routine dental services are not covered.
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.
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.
Does MassHealth cover cosmetic dentistry or whitening?
No. Cosmetic procedures such as whitening, veneers, and elective cosmetic services are not covered.
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 or request an appointment online to schedule your visit.
