Jane Dotson
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program, which includes a dental plan. This plan, provided by companies such as Humana and DentaQuest, covers dental services for children and adults, including emergency procedures, screenings, assessments, diagnoses, prevention, and treatment of oral diseases and disorders.
| Characteristics | Values |
|---|---|
| Name of Dental Insurance | Humana Healthy Horizons, DentaQuest |
| Dental Plan Requirements | All people on Medicaid must enroll in a dental plan |
| Dental Plan Coverage | All Medicaid dental services for children and adults |
| Dental Plan Benefits | Dental services for the study, screening, assessment, diagnosis, prevention, and treatment of oral diseases, disorders, and conditions |
| Dental Plan Services | Help to choose or change dentists, find out if a service is covered, get referrals, find a provider, replace a lost ID card, and explain any changes that might affect dental benefits |
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What You'll Learn
Florida's Statewide Medicaid Managed Care program
In Florida, the Agency for Health Care Administration (AHCA) is responsible for administering the Statewide Medicaid Managed Care (SMMC) program. The SMMC program was created in 2011 and fully implemented in 2014. The program provides access to healthcare for low-income families and individuals, including the elderly and people with disabilities. It has three main parts: Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental.
Under the SMMC program, most Medicaid recipients in Florida are enrolled in dental plans. These dental plans provide all Medicaid dental services for children and adults, helping them maintain good oral health. Regular dental check-ups are recommended for babies, children, and adults to prevent cavities and gum disease. Dental plans also help individuals find a dentist, choose or change dentists, find out if a service is covered, get referrals, and more.
To enrol in a dental plan, individuals can contact Florida's enrollment broker at 877-711-3662 (TTY: 711). Once enrolled, individuals will receive a dental ID card separate from their health plan member ID card. This dental ID card is important for accessing dental services and benefits.
Florida Medicaid dental plans cover a range of services, including emergency dental care and preventative care. Some services may require prior authorization, meaning permission from the dental plan is needed before the service is performed. It is important to contact the chosen dental plan to understand the specific services covered and any requirements or limitations.
The SMMC program has changed how some individuals receive their long-term care from the Florida Medicaid Program. The LTC component of the SMMC program provides Medicaid LTC services, such as care in nursing facilities, assisted living facilities, or at home. To be eligible for LTC services, individuals must meet specific criteria, including being at least 18 years old and meeting the nursing home level of care.
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Dental plan enrolment
In 2016, the Florida Legislature directed the Agency for Health Care Administration (AHCA) to enroll most Medicaid recipients into dental plans. All people on Medicaid must enroll in a dental plan.
Florida Medicaid Managed Care
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. People on Medicaid will get services using one or more of these plan types.
Managed Medical Assistance (MMA)
MMA provides Medicaid-covered medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services. Most people on Medicaid will receive their care from a plan that covers MMA services.
Long-Term Care (LTC)
LTC provides Medicaid LTC services like care in a nursing facility, assisted living facility, or at-home care. To be eligible for LTC, you must be at least 18 years old and meet nursing home-level care (or meet hospital-level care if you have Cystic Fibrosis).
Dental
The Dental plan provides all Medicaid dental services for children and adults. Florida Medicaid wants to ensure children have healthy teeth and offers a list of services to help at no cost. These services include emergency-based dental care. Some services may require permission from a dental plan before the dentist performs the service. This is called prior authorization. Services must be medically necessary for dental plans to pay for them.
Enrolling in a Dental Plan
To enroll in a dental plan, you will need your pin (from the letter) along with the Florida Medicaid or Gold Card Number, and birth year for each person you are enrolling. You can call Medicaid Choice Counselors to help you enroll in a plan that best fits your needs. They can be reached at 1-877-711-3662, Monday to Thursday from 8:00 am to 8:00 pm, and Friday from 8:00 am to 7:00 pm. You will need the Florida Medicaid or Gold Card Number and birth year for each enrollee. If you do not have this information, you may contact your Department of Children and Families office.
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Dental services covered by Medicaid
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program, which includes dental services for children and adults. The program has three parts: Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental.
The Dental component of the program covers all Medicaid dental services. While there is limited information on the specific dental procedures covered by Medicaid, it reimburses for dental services that provide for the study, screening, assessment, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity. This includes acute emergency dental procedures to alleviate pain or infection, as well as dentures and denture-related procedures for recipients aged 21 and older.
Florida Medicaid is committed to ensuring that recipients receive high-quality dental care and have access to a dentist and a dental home. Dental plans under Medicaid will help children and adults find a dentist, choose or change dentists, and provide referrals. Additionally, Medicaid health plans provide transportation to dentist appointments if needed.
To access dental services under Medicaid, recipients must enroll in a dental plan and may require prior authorization from the plan before receiving certain services. Dental services must be medically necessary for the dental plan to cover the costs.
It is recommended that babies, children, and adults see a dentist regularly, at least twice a year, to maintain good oral health and prevent dental problems. Florida Medicaid provides resources to help recipients maintain good oral hygiene practices and emphasizes the importance of oral health for overall health.
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Choosing a dental plan
In 2016, the Florida Legislature directed the Agency for Health Care Administration to enrol most Medicaid recipients into dental plans. All people on Medicaid must enrol in a dental plan. The Statewide Medicaid Managed Care program has three parts: Managed Medical Assistance, Long-Term Care, and Dental.
Dental plans will help children and adults find a dentist and a dental home. They will also help choose or change dentists, find out if a service is covered, get referrals, find a provider, replace a lost ID card, and explain any changes that might affect dental benefits.
Florida has various dental insurance companies, including Florida Blue, Cigna, United Healthcare, Delta Dental, Humana, Aetna, Metlife, AARP, Guardian Dental, and AFLAC Dental. These companies offer a range of dental plans, including HMO, PPO, and dental savings plans. PPO plans are the most popular as they allow you to choose an in-network dentist while still giving you the option to visit an out-of-network doctor. HMO plans are also available and provide coverage at reduced rates, but benefits are limited to in-network providers with a prior referral from a primary care provider.
When choosing a dental plan, it is important to consider your budget and the specific services you require. Some plans offer a wide range of benefits, while others are more limited. It is also important to consider the size of the provider network and whether you will be able to choose your own dentist. Reading reviews and comparing prices from different providers can help you make an informed decision.
Florida also has various dental discount plans available, which are not insurance but can offer discounted rates at participating dentists. Dental discount plans can be found by searching online or asking a dentist for recommendations.
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Medicaid dental coverage providers
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program, which includes dental coverage. This program is split into three parts: Managed Medical Assistance, Long-Term Care, and Dental.
All people on Medicaid must enroll in a dental plan. The Florida Legislature directed the Agency for Health Care Administration to enroll most Medicaid recipients into dental plans in 2016. These plans are separated into phases based on the recipient's county location.
There are several Medicaid dental coverage providers in Florida, including:
- Humana: Humana Healthy Horizons in Florida is a Medicaid product of Humana Medical Plan, Inc.
- DentaQuest: DentaQuest is a dental plan with a Florida Medicaid contract.
To find out which dental plan you are enrolled in, you can contact Medicaid Choice Counseling. They will be able to provide you with information about your dental coverage and benefits. You can also contact your dental plan directly to learn more about your coverage and when to expect your dental ID card.
Medicaid dental plans in Florida cover a range of services for children and adults, including regular check-ups, cleanings, x-rays, and emergency dental procedures. It is recommended that babies, children, and adults see a dentist regularly to maintain good oral health and prevent problems like toothaches and gum disease.
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Frequently asked questions
There is no specific name for Medicaid dental insurance in Florida. However, there are several companies that offer Medicaid dental plans, including DentaQuest and Humana Healthy Horizons.
Yes, all people on Medicaid in Florida must enroll in a dental plan.
You can use the easy-to-use search tool on the Florida Medicaid website to find a dentist nearby and choose a dental plan that suits your needs. You can also call 1-877-711-3662 to speak to a Choice Counselor for guidance.
Dental plans cover a range of services, including check-ups, cleanings, and x-rays. Some emergency-based dental services are also covered. However, some services may require prior authorization, meaning you will need permission from your dental plan before the service is performed.
It is recommended that babies, children, and adults see a dentist at least twice a year. Children should start seeing a dentist by age 1, even if they don't have teeth yet. Regular dental check-ups can help prevent cavities and gum disease.
