Adult
Medi Cal Dental Benefits

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.

See also smile california.org 

 

Adult Dental benefits   

Dental Provider Handbook,

Our webpage on Oral Health for Seniors

DHCS Medi-Cal Dental Program

denti-cal.ca.gov

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:

Medi Cal #Vision Benefits

Governor Newsum’s 2019 budget includes money to restore — at least for the next two years — a variety of services that were deemed nonessential during the recession: optical services, podiatry, help for incontinence issues, audiology and speech therapy. Those services will be available starting Jan. 1.  LA Times 6.28.2019 *  LA Times 6.13.2019 *

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

dhcs.ca.gov/VisionBenefits

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Direct Phone # for Medi Cal
866.613.3777
Direct Phone # 866.613.3777

Dental For #Everyone,
has an excellent  website with full brochures, Instant online quoting and enrollment

Dental for everyone free quote

VSP Vision Enroll ONLINE

15 comments on “Denti Cal & Vision

  1. 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?.

      • 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?

          ***********************

          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

  2. 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:

      “For individuals enrolled in Medi-Cal, then they are automatically enrolled in Denti-Cal. Clients may call 1-800-322-6384 for a list of providers in their county or visit the DHCS website for a list of Denti-Cal providers. They may check out the state website for Denti-Cal: https://www.denti-cal.ca.gov/ for more information.

      If they come in to one our offices or call, the worker may direct them to the 800# or may provide them with some numbers to local dental providers.

      Calling the 800# would be easier if all they want is to get information on where they can go to see a dentist. They just need to present their Medi-Cal BIC card to a dental office that excepts Medi-Cal/Denti-Cal. If the client has lost their State Medi-Cal BIC card they may call or visit their county of residence Medi-Cal office to request a BIC card.

      Hope this is helpful.”
      See also Denti Cal Manual page 4

      My Medi Cal brochure page 13

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