Adult Medi Cal Dental Benefit
Full Restoration Effective January 1, 2018
Medi-Cal offers comprehensive preventative and restorative dental benefits to both children and adults.
You can find a Medi-Cal dentist on the Denti-Cal Provider Referral List, or by calling 1-800-322-6384.
Adult Dental benefits fully restored adult optional dental benefits
- Laboratory processed crowns,
- posterior root canal therapy,
- periodontal services,
- and partial dentures, including denture adjustments, repairs, and relines.
- Pregnancy-related services
- Emergency services
- Services provided to residents of an Intermediate Care Facility/Skilled Nursing Facility
- Services provided to consumers of the Department of Developmental Services
- Implants?? Senate Bill 97 – 2017
Our webpage on Oral Health for Seniors
Links & Resources
californiahealthline.org/ February 2014
Our website is #MUCH more than just
Pro Bono helping you with Medi-Cal
We've developed the Medi-Cal portion of our website, as many of our Covered CA clients unfortunately end up here, if their income drops below 133% of FPL, Federal Poverty Level, see the income chart.
We do not get a nickel, for this site or for helping people enroll in Medi-Cal, nor answering complex questions. When you have other questions or need coverage, take a look at our other websites:
The following vision services are covered for Medi-Cal Members:
Medically Necessary eye examinations for Diagnosis, treatment or prevention of eye disease or detection of ophthalmologic complications of medical disease.
Routine eye examination (refraction) every two years. Members may self-refer to obtain routine vision services from a participating optical Provider. Members may contact Member Services at 1-800-675-6110 to obtain a directory of participating optometrists and ophthalmologists.
Eye examination every year by an ophthalmologist or optometrist for Members with diabetes or other Chronic medical problems affecting the eye
Medical eye exams by an ophthalmologist or optometrist for Acute or Urgent Care
Contact lenses when Medically Necessary are covered for Eligible Medi-Cal Members 20 and under or Members residing in Skilled Nursing Facilities (SNFs). Adults 21 and over are covered for bandage contacts only when Medically Necessary; other ophthalmological materials are not covered.
Optical lenses and frames (every two years) for Members under age 21, pregnant women if your doctor says not having them will be harmful to your baby or pregnancy, and people living in a nursing home. Optical lenses are made by the California Prison Industry Authority (CALPIA) optical laboratories unless you are being seen by an Authorized Mobile Vision Service provider (LA County only); however, our plan or the delegated participating Medical Group, as applicable, will arrange for this service. Optical lenses and frames for Members age 21 and over are not a covered benefit Health Net Evidence of Coverage Page 30
Links & Resources
Denti Cal Beneficiary Handbook
4 page summary of Denti Cal benefits from Justice in Aging
ABC News Video – Denti Cal benefits restored
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Direct Phone # for Medi Cal
866.613.3777
Dental For #Everyone,
has an excellent website with full brochures, Instant online quoting and enrollment
- One of our colleagues on how Dental for Everyone Works.
- Sample Quote
- Blue Cross Dental & Vision
- Dental with the new Extra & Innovative Medi Gap Plans Plan F Extra – Dental
- Blue Shield Medicare Advantage Dental & Vision
Medi Cal won’t pay my dentist, what can I do?
What dental services did you get?
Did you go to a dentist that is on the Medi Cal dental provider list?
https://dental.dhcs.ca.gov/Beneficiaries/Denti-Cal/Find_A_Dentist/
Please send us privately a copy of your Denti Cal & Medi Cal card.
What Medi Cal program did you qualify under?
Aged & Disabled?
https://medi-cal.healthreformquotes.com/eligibility/aged-and-disabled/
Share of Cost???
https://medi-cal.healthreformquotes.com/eligibility/aged-and-disabled/share-of-cost/
MAGI Medi Cal?
https://medi-cal.healthreformquotes.com/eligibility/
Please also send us privately all the paper work, bills, denials, etc.
https://www.paubox.com/steveshorr/upload
My son has private dental insurance thru he’s father’s employer and denti-cal as secondary. He has a dentist appointment and I was told that I have to pay the deductible and co insurance because denti cal won’t pay for that.
Is that true?.
Is your dentist a Denti-Cal Provider? https://www.denti-cal.ca.gov/find-a-dentist/home
What service is your child getting?
Denti Cal Handbook
Rules on dual coverage – private pays first
Yes, they are providers
they are doing 2 fillings but she said that because on the eligibility it shows he has cigna
denti cal won’t pick up the deductible and co insurance
that they want me to pay the day of he’s visit.
Medi-Cal will cover services that are not available under the private policy in addition to deductibles and copayments. https://ca.db101.org/ca/programs/health_coverage/medi_cal/faqs.htm
Do you have a pre-paid managed care plan? HMO? Is your dentist part of that plan? On Medi Cal? On CIGNA? https://www.denti-cal.ca.gov/Beneficiaries/Beneficiary_Frequently_Asked_Questions/
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your dentist cannot ask you to pay for any treatment that is covered by Medi-Cal Dental.
The dentist cannot charge you for private insurance cost-sharing amounts such as
deductibles, co-insurance or copayments.
What if I get a bill from the dentist?
First, you should call your dental office and ask them why they sent you the bill. The dental
ofce will explain the charges and why they are asking you to pay. For example, if you have
a share of cost amount, you will need to pay that amount before the dentist can ask
Medi-Cal Dental to pay for the treatment. Or, if you get an agreed upon treatment that
is not covered by Medi-Cal or other insurance, you will have to pay the dentist for that
treatment.
If you still have questions about what your dentist is charging you and/or what Medi-Cal
Dental pays for, call the TSC.
Medi-Cal Dental Telephone Service Center:
1-800-322-6384
What happens if I have other dental insurance?
Your dentist must bill your other dental insurance before asking Medi-Cal Dental to pay
for any treatment. The Medi-Cal Dental Program does not pay any benefts you can
get through other dental insurance including other government programs, TRICARE
(CHAMPUS) or Workers’ Compensation. Coverage provided under Medi-Cal is secondary to
all other coverage.
If you have other dental insurance that does not pay for a service that is covered by
Medi-Cal Dental, or pays less than the amount paid by Medi-Cal Dental, your dentist will
send a claim to Medi-Cal Dental for any unpaid amount. Your dentist cannot ask you to pay
for any treatment that is covered by Medi-Cal Dental.
https://www.denti-cal.ca.gov/DC_documents/beneficiaries/DC_member_handbook_english.pdf
If I’m enrolled in Medi-Cal, am I automatically signed up for Denti-Cal?
If not, how do I enroll?
Reply from San Mateo via Covered CA Agent Support
I received this back from a county representative from San Mateo County:
Hope this is helpful.”
See also Denti Cal Manual page 4
My Medi Cal brochure page 13
If I have Share of Cost Medi-Cal, is that an issue?
Doesn’t look that way. Double check with your Social Worker.