Coverage for Dental Implants?

Liberty Dental Plan!

Liberty Dental DHMO plan features large group type benefits, but is not rated by age or zip code, and individuals and/or groups with no participation requirements!  

 Benefits Include: 

No Annual Maximums, No Claim Forms, Coverage for Pre-Existing Conditions, No Waiting Periods, Orthodontia, Dental Implants and More. 

Brochure and Enrollment Kit

• Brochure
• Liberty Provider Directory
• Liberty Dental Enrollment Forms
• Copayment Schedule of Benefits
  • Implants Page 7
• Liberty Online Provider Directory *

 *When using the online provider link, select the CA-400 plan (not to be confused with the CA-400-R Plus) from the Benefit Plan /Network drop down. You will have to scroll down about half way to find it. Then select Zip Code, Country, State and City and click on the Search button.

#Alternatives to Implants

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• Denture  FOY Fountain of Youth VIDEO’s  High End Dentures – Better than what your Parents wore
• Interviews – Testimonials VIDEO –

FAQ’s Medi Cal & Dental #Implantsx

• Do you have an “OFFICIAL” explanation from Medi Cal on how implants are covered or not?
  • Hi Steve,
  • A Medi-Cal member is eligible for dental services provided by the Medi-Cal Dental Program.  Eligibility for benefits is determined by the member’s local county social services office and reported to the State of California.  The State, in turn, issues a Medi-Cal Benefits Identification Card (BIC) to members who are eligible for Medi-Cal Benefits. Limitations or restrictions of dental services may apply in certain situations.
  • Medi-Cal offers a broad base of dental benefits, please refer to SmileCalifornia.org for information about Medi-Cal’s dental benefits. With respect to your specific question regarding full mouth implants, implant services are a benefit only when exceptional medical conditions are documented, and those conditions are reviewed by the Medi-Cal Dental Program for medical necessity (as defined by law) for prior authorization.  Some of those exceptional medical conditions are:
    • 1). Cancer of the mouth requiring extensive surgery such that a conventional denture can no longer be worn.
    • 2). A skeletal deformity that precludes the use of a conventional denture.
    • 3). Traumatic destruction of jaw, face or head which makes a conventional denture impossible to wear.
  • Furthermore, single tooth implants are not a benefit of the Medi-Cal Dental Program. If the member has an exceptional medical condition, the assigned dental and medical providers will need to get together and fully document the medical and dental needs in writing.
    • Providers shall submit a complete case documentation (to include such items as radiographs, scans, operative reports, craniofacial panel reports, diagnostic casts, intraoral/extraoral photographs and tracings) necessary to demonstrate the medical necessity of the requested implant services.
      • If the member has existing dentures that do not fit, there are ways to modify them (such as tissue conditioners and relining them) to aid in their retention. This is a conversation the member will need to have with their regular dentist.  Modification of existing dentures and even fabrication of new dentures (a benefit once in a five-year period) are benefits of the Medi-Cal Dental Program with prior approval.

  • Thank you,

    Monique Garcia

    Chief of Provider and Beneficiary Services Section

    Medi-Cal Dental Services Division

• Can I get implants from iehp? Medi Cal? Denti-Cal?
  • • I’m In need for dental implants and am low income. Two pair of dentures that don’t fit properly. Can’t chew food without teeth.
  • REPLYSee below or to the right  for the Denti Cal – Medi Cal Member HandbookI’ll grant, that I don’t see on that page anything about implants, so here’s our research.
    • The Denti-Cal provider handbook does mention Implants, so I guess it’s covered. I suggest you ask your dentist. Your question is beyond my pay grade! (Zero, as Medi Cal doesn’t pay agents)These are the “codes” in the provider manual that related to implants:
      • Implant ServicesD6010, D6040, D6050, D6053, D6054, D6055, D6056,D6057, D6058, D6059, D6060, D6061, D6062, D6063,D6064, D6065, D6066, D6067, D6068, D6069, D6070,D6071, D6072, D6073, D6074, D6075, D6076, D6077,D6078, D6079, D6080, D6090, D6091, D6094, D6095,D6194, D6199See also Dental Economics.com
    • Here’s why I don’t like to guess or answer questions on the phone. I checked with justice in aging.org/ and said
      • “Single tooth implants are not a benefit of the Medi-Cal Dental Program”Some legal advocates have attempted to make compelling medically necessary arguments, and the provider manual allows for that “Implant services are a benefit only when exceptional medical conditions are documented and shall be reviewed for medical necessity.”But generally speaking not a benefit and not one we want to promote as available to Medi-Cal beneficiaries since they are so limited.they pointed out this section in the provider handbook:Implant Services General Policies (D6000-D6199)a) Implant services are a benefit only when exceptional medical conditions are documented and shall be reviewed by the Medi-Cal Dental Program for medical necessity for prior authorization. Exceptional medical conditions include, but are not limited to:
        

        i) cancer of the oral cavity requiring ablative surgery and/or radiation leading to destruction of alveolar bone, where the remaining osseous structures are unable to support conventional dental prostheses.
        ii) severe atrophy of the mandible and/or maxilla that cannot be corrected with vestibular extension procedures or osseous augmentation procedures, and the patient is unable to function with conventional prostheses.
        iii) skeletal deformities that preclude the use of conventional prostheses (such as arthrogryposis, ectodermal dysplasia, partial anaodontia and cleidocranial dysplasia).
        iv) traumatic destruction of jaw, face or head where the remaining osseous structures are unable to support conventional dental prostheses.

        b) Providers shall submit complete case documentation (such as radiographs, scans, operative reports, craniofacial panel reports, diagnostic casts, intraoral/extraoral photographs and tracings) necessary to demonstrate the medical necessity of the requested implant services.
        c) Single tooth implants are not a benefit of the Medi-Cal Dental Program.
        d) Implant removal, by report (D6100) is a benefit. Refer to the procedure for specific requirements.

        They also told me about this guide for dental care for older adults

    • Do you have Medicare?  We could look into MAPD Medicare Advantage plans that might offer implant coverage or a quartley spending account that could be used for implants?
• I’m not in CA.   Can you help me with questions on Medicaid or Medicare Advantage plans in my state.
  • Sorry no.  Try the  NAHU National Assoc. of Health Underwriters Agent finder,   of course try your EOC evidence of coverage or the SHIP State Health Insurance Assistance Program finder 
• 1. Searching for a reasonable rate plan for bone grafting…?
  2. How does dental cal, provide for patients that need bone grafting before implants…?
  • See above, doesn’t look like Denti Cal will cover it.
  • What about alternatives to Implants?
• See our FAQ and comments section below for more FAQ’s or to ask a question

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