MassHealth Insurance
MassHealth Dental Insurance Plans
Eligibility
Understanding Your Benefits
Your MassHealth dental benefits depend on your plan type and age. Children typically receive the broadest level of coverage. Adults receive comprehensive care and DDS members may qualify for enhanced coverage. Some treatments may require prior authorization.
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. 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+)
- 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 (may require prior authorization)
DDS (Department of Developmental Services) Patients
Adults enrolled in DDS programs may receive expanded dental benefits, often similar to the coverage available for children. Coverage may include additional preventive, restorative, and medically necessary procedures. We work closely with DDS case managers to ensure coordinated care.
Prior Authorization
Certain procedures require MassHealth approval before treatment—especially orthodontics, periodontal services, major restorative care, and complex oral surgery. Our administrative team handles all prior authorization submissions for you and keeps you informed every step of the way.
MassHealth Limited
MassHealth Limited offers emergency dental coverage only. Emergency services include treatment needed to relieve severe pain, infection, swelling, or conditions that pose a health risk. If you are enrolled in MassHealth Limited, call our office and we will review what emergency services may be covered.
Children’s Medical Security Plan (CMSP)
- Exams and cleanings
- Fluoride treatments
- Sealants
- Fillings
- Limited restorative procedures
Frequently Asked Questions
What dental services are covered for adults under MassHealth?
Are children fully covered under MassHealth?
Yes, children under 21 receive the most comprehensive benefits, including preventive and restorative care, some orthodontic coverage (with prior authorization), and medically necessary procedures.
Does MassHealth cover emergency dental treatment?
Yes. All MassHealth plans cover emergency dental care needed to treat severe pain, swelling, infection, or trauma.
What is MassHealth Limited?
MassHealth Limited provides emergency-only dental coverage. This includes treatment to relieve pain or stop infection. Routine care is not covered under Limited.
Will I have out-of-pocket costs?
Most medically necessary services are fully covered. If treatment isn’t covered or requires an upgrade (for example, premium denture materials), we will review your options and any potential costs before starting care.
Do I need a referral from my primary care provider?
No referral is needed for dental visits under MassHealth.
What if I’m unsure whether I’m eligible for MassHealth?
Our front desk team can help you check eligibility and coverage in minutes. Just bring your MassHealth ID or provide your information by phone.
Does MassHealth cover dental implants?
In most cases, implants are not covered. MassHealth may cover alternative medically necessary options such as dentures or partials.
Does MassHealth cover braces?
Can I switch to a different MassHealth managed care plan?
Yes. You can switch plans during your enrollment period or under qualifying circumstances. Visit the MassHealth website for details.
Our Service Area
Smiley Dental Beverly proudly serves patients from Beverly and nearby North Shore communities, including:
Danvers, Peabody, Salem, Wenham, Hamilton, Gloucester, Manchester-by-the-Sea, Ipswich, and surrounding areas.
📞 Call us today at 978-288-1000 to schedule your appointment.
