Mar 23, 2026
Medicaid Dental Benefits in Hudson County & West New York: Complete Coverage Guide
You've been putting off dental care because you're worried about cost. Maybe you're on a tight budget. Maybe you've heard that dental work is expensive and you can't afford it. Then you remember: you have Medicaid. But how much does Medicaid actually cover? What can you get, and what do you have to pay out of pocket? If you're in this situation, you're not alone, and you're right to ask these questions.
The truth is that Medicaid is a game-changer for people who need dental care but can't afford to pay full price. Unlike many dental insurance plans that have high deductibles and limited coverage, Medicaid provides surprisingly comprehensive dental benefits. The catch is that the details matter. Coverage varies by plan and by the specific treatment you need. Understanding what's covered and what's not covered can help you maximize your benefits and make informed decisions about your dental care.
At Veda Family Dentistry in West New York, we've been accepting Medicaid for years, and we understand the system inside and out. We've helped hundreds of Medicaid patients navigate their coverage, access the care they need, and achieve better oral health. In this comprehensive guide, we'll explain exactly how Medicaid dental coverage works in Hudson County, what procedures are covered at what percentage, how to apply if you don't have Medicaid, and what financing strategies work for procedures Medicaid doesn't cover. By the end of this guide, you'll understand your options and be able to make confident decisions about your dental care.
Understanding Medicaid Dental Coverage: What's Included and What's Not
Medicaid dental coverage in New Jersey is divided into three categories: preventive, basic restorative, and major restorative. Each category has different coverage levels, and understanding the difference is crucial.
H3: Preventive Services (100% Covered)
Preventive services are fully covered by Medicaid, which means you pay nothing out of pocket. These include:
Dental exams (typically twice per year)
Professional cleanings (typically twice per year)
X-rays and digital imaging
Fluoride treatments (for eligible patients, typically children and some young adults)
Sealants on molars (typically for children)
This is excellent news because preventive care is the foundation of good oral health. Regular cleanings and exams catch problems early, when they're easier and less expensive to treat. The fact that Medicaid covers these services fully means there's no financial barrier to staying on top of your dental health.
Basic Restorative Services (50-70% Covered)
Basic restorative services are covered at 50 to 70 percent, meaning Medicaid pays half to 70 percent of the cost, and you're responsible for the remaining 30 to 50 percent. These include:
Fillings (to treat cavities)
Extractions (tooth removal)
Root canals (endodontic treatment)
Scaling and root planing (for gum disease)
Simple crowns
Dentures (sometimes)
For example, if a filling costs $150, Medicaid might pay $100, and you'd pay $50. If a root canal costs $1,000, Medicaid might pay $700, and you'd pay $300. The exact percentages vary depending on your specific plan, which is why it's important to verify coverage before treatment.
Major Restorative Services (Limited or Not Covered)
This is where it gets tricky. Major restorative services, which are the most expensive treatments, are often not covered or only partially covered by Medicaid. These include:
Dental implants (usually NOT covered)
Bridges (sometimes covered, sometimes not)
Crowns (some coverage, but often limited)
Complex orthodontics (limited coverage)
Cosmetic dentistry (NOT covered)
Advanced bone grafts (usually not covered)
This is one reason why many Medicaid patients face difficult choices. They might need an implant to replace a missing tooth, but Medicaid won't cover it. They might need a bridge, but coverage is limited. This is where understanding your options and exploring financing strategies becomes crucial.
The Medicaid Coverage Example
Let's walk through a realistic example. Sarah has a decayed tooth and Medicaid dental coverage. Her options are:
Option 1: Root canal and crown to save the tooth. Estimated cost: $1,500. Medicaid covers 60% of basic services (root canal) and 50% of major services (crown). She pays: approximately $700. Medicaid pays: approximately $800.
Option 2: Extraction. Cost: $200. Medicaid covers 60%. She pays: $80. Medicaid pays: $120.
Option 3: Extraction plus implant to replace the tooth. Cost: $200 (extraction) + $6,000 (implant) = $6,200. Medicaid covers the extraction but NOT the implant. She pays: approximately $6,120. Medicaid pays: approximately $80.
As you can see, the coverage varies dramatically depending on the treatment option. This is why having a conversation with your dentist about what Medicaid covers is so important.
Medicaid Eligibility: How to Qualify
Not everyone qualifies for Medicaid, but the eligibility criteria are relatively straightforward. In New Jersey, Medicaid dental coverage is available to:
Income Levels and Family Size
Medicaid eligibility in New Jersey is based on your income relative to the Federal Poverty Level. The income limits change annually, but as a general guide, a single adult with an income below approximately $1,400 per month qualifies, and a family of four with income below approximately $2,800 per month qualifies. These are approximate figures, and the exact limits depend on the current year. Check the New Jersey Department of Human Services website for the current income limits.
Age Categories
Different age groups have different coverage. For example:
Children (under 21) typically have comprehensive coverage, including orthodontics
Adults (21 and older) have more limited coverage
Seniors (65 and older) might have different coverage through Medicare
If you have children, make sure to take advantage of the more comprehensive coverage available to them, especially preventive services and orthodontics if needed.
Immigration Status
Medicaid eligibility varies based on immigration status. Citizens and permanent residents generally qualify if they meet income requirements. Undocumented immigrants are generally not eligible for regular Medicaid, but they may qualify for emergency Medicaid if they need emergency dental treatment. This is an area where the rules are complex, so ask Dr. Priya or our staff if you have questions about your specific situation.
Other Qualifying Factors
Beyond income and age, you might also qualify if you:
Are pregnant (emergency dental coverage)
Are disabled
Are receiving SSI (Supplemental Security Income)
Are a refugee (within 8 months of arrival)
Are receiving TANF (Temporary Assistance for Needy Families)
How to Apply for Medicaid Dental Coverage
If you don't currently have Medicaid but think you qualify, applying is straightforward.
Apply Online
The easiest way to apply is through the New Jersey benefits website at www.nj.gov/humanservices. You can complete an online application, which takes about 15 minutes. You'll need to provide information about your income, family size, and other household members.
Apply in Person
If you prefer to apply in person, you can visit your local Department of Human Services office. In Hudson County, there are several locations. Staff can help you complete the application and answer questions about eligibility.
Apply by Mail or Phone
You can also apply by mail or phone, though online is typically faster.
What Documentation You'll Need
When you apply, you'll need:
Proof of income (recent pay stubs, tax return, or proof of benefits)
Proof of residency (utility bill or lease)
Social Security numbers for all family members
Information about any health insurance you currently have
Timeline for Approval
After you apply, the state has 30 days to approve or deny your application (45 days in some cases if they need more information). Once approved, your coverage typically begins the first day of the month after approval. You'll receive a Medicaid card in the mail, which you can use immediately at participating providers like Veda Family Dentistry.
How Veda Family Dentistry Works with Your Medicaid
One of the biggest advantages of coming to Veda Family Dentistry is that we handle all the Medicaid paperwork for you. This is a huge relief because the Medicaid system can be confusing and time-consuming. Here's how we make it easy.
Verification of Benefits
Before your first appointment, our billing team will verify your Medicaid coverage. We contact your Medicaid plan directly to confirm:
That your coverage is active
What procedures are covered
What your out-of-pocket costs will be
Any waiting periods or limitations
This means you'll know exactly what you're going to pay before you receive treatment. No surprises. No unexpected bills. This is crucial because many Medicaid patients worry about hidden costs, and we eliminate that worry.
Pre-Authorization
Many procedures require pre-authorization from Medicaid, meaning we need approval before we provide treatment. Our billing team handles this. We submit the pre-authorization request, get approval, and then schedule your treatment. You don't have to do anything. We handle it all.
Filing Claims
We file all claims with your Medicaid plan on your behalf. Once treatment is complete, we submit the claim and follow up to make sure it's paid. We also handle any claim denials, appealing if necessary. You'll never have to deal with claim paperwork.
Explaining Your Bill
After your treatment, if you have any out-of-pocket costs, we'll explain exactly what you're paying for and why. We might also discuss payment options if you need to spread out larger out-of-pocket costs.
Why This Service Matters
Many Medicaid patients have had the experience of going to a dental office, getting treatment, and then being hit with a huge bill because the office didn't file insurance correctly or didn't get pre-authorization. This causes huge stress and resentment. We're committed to making sure this doesn't happen to you. We handle the system so you don't have to.
Navigating Waiting Periods and Pre-Authorization Requirements
Medicaid dental plans sometimes have waiting periods for certain procedures, and virtually all plans require pre-authorization for major procedures. Understanding these requirements helps you plan your treatment.
Waiting Periods
Some Medicaid plans have waiting periods, which means you have to have active coverage for a certain period before certain procedures are covered. For example, you might have to wait 12 months before major restorative services (crowns, bridges, implants) are covered. Preventive services are usually available immediately, even if you just enrolled.
Our billing team will tell you about any waiting periods that apply to you, so you can plan accordingly.
Pre-Authorization Procedures
Before we provide certain treatments, Medicaid requires pre-authorization. This is especially true for:
Crowns and bridges
Root canals
Complex fillings
Scaling and root planing (deep cleaning)
Dentures
Extractions (sometimes)
We submit the pre-authorization request several days before your scheduled appointment. Usually, we get approval within a few days. In rare cases where pre-authorization is denied, we'll discuss alternative treatment options with you.
Why Pre-Authorization Exists
Pre-authorization isn't just Medicaid being difficult. It's actually a way to make sure treatments are medically necessary and appropriate. It protects you by ensuring you don't receive unnecessary treatment. It also protects Medicaid by preventing fraud and abuse.
Financing Procedures Medicaid Doesn't Cover
Medicaid has limits, and sometimes you need treatment that Medicaid won't cover. The good news is that you have options.
Medicaid Doesn't Cover Implants: Here's What You Can Do
This is the most common situation we encounter. A patient needs a missing tooth replaced, and they ask about an implant. We explain that Medicaid doesn't cover implants. Their heart sinks. But then we present alternatives:
Option 1: Bridge (Sometimes Covered)
A bridge is a tooth replacement option that uses the adjacent teeth as anchors. It's sometimes covered by Medicaid (usually at 50% coverage), though coverage varies by plan. Cost is usually $2,000 to $5,000 for a three-tooth bridge. Your Medicaid might cover $1,000 to $2,500, and you'd pay the rest.
The advantage of a bridge is that Medicaid might cover part of it. The disadvantage is that it requires grinding down healthy adjacent teeth (which weakens them), and it doesn't prevent bone loss in the missing tooth area.
Option 2: Denture (Covered by Medicaid)
A denture (partial or complete) is typically covered by Medicaid at 50% to 100%, depending on your plan. Cost for a partial denture is usually $1,500 to $3,000. Medicaid might cover most or all of it.
The advantage is that Medicaid covers most of the cost. The disadvantage is that dentures require maintenance, replacement every 5 to 7 years, and adjustment as your bone resorbs over time. They also require daily cleaning and care, and some people find them uncomfortable or difficult to adjust to.
Option 3: Implant with Financing
Some patients choose to get an implant even though Medicaid won't cover it. They use financing to make it affordable. Here's how:
You pay for the extraction with Medicaid coverage (50-70% covered, so you pay 30-50%). Then you finance the implant portion using CareCredit or an in-house payment plan. Total cost for a single tooth implant is typically $6,000 to $8,000. With CareCredit at 0% APR for 24 months, you'd pay about $250 to $330 per month. For many people, this is manageable.
The advantage of this approach is that you get a permanent solution that preserves bone and lasts for decades. The disadvantage is that you have an out-of-pocket cost that Medicaid doesn't cover.
Option 4: Phased Approach
Another option is to do treatment in phases. For example:
Year 1: Get a denture (Medicaid covers most). Preserve your remaining teeth.
Year 2-3: When you have saved money or financing is arranged, get an implant to replace the most visible missing tooth.
Year 4+: Get additional implants as finances allow.
This approach allows you to have some restoration immediately while working toward a more permanent solution.
CareCredit and In-House Payment Plans: Making Treatment Affordable
For procedures that Medicaid doesn't cover or only partially covers, we offer two financing options.
CareCredit: 0% APR for Qualified Purchases
CareCredit is a medical credit card that allows you to make purchases with 0% APR for 12, 18, or 24 months if you pay off the full balance during the promotional period. Here's how it works:
You apply for CareCredit (the application takes 5 minutes). If approved, you receive a credit limit (which could be $500 to $25,000 depending on your creditworthiness). You use the card to pay for treatment. You then make monthly payments to pay off the balance within the promotional period. If you pay off the full balance during the promotional period, you pay zero interest.
CareCredit Example
Let's say you need an implant that costs $7,000. Medicaid covers the extraction ($100 of the cost). You need to pay $6,900. You apply for CareCredit, get approved for a $7,000 limit, and charge the $6,900 to the card. You choose the 24-month promotional period. Your monthly payment is approximately $287 per month for 24 months, and you pay zero interest.
CareCredit often approves people with less-than-perfect credit because they understand that healthcare expenses are necessary. If you don't have great credit, you still have a good chance of approval.
Important CareCredit Terms
Make sure you understand the terms before you sign up:
You MUST pay off the full balance during the promotional period, or you'll be charged interest retroactively on the entire balance
If you miss payments, you might lose the promotional rate
Always make at least the minimum payment on time
In-House Payment Plans
We also offer our own payment plans, which don't require a credit check or approval process. Here's how they work:
You and Dr. Priya or Dr. Moosavi agree on a payment plan that works for your budget. For example, you might agree to pay $200 per month for 36 months for an $7,200 implant. No interest. No application. No credit check. Just an agreement between you and us.
Who Should Choose In-House Plans?
In-house plans are great if:
You don't qualify for CareCredit
You prefer not to use credit
You want flexibility in your payment schedule
You want to avoid any possibility of interest charges
We're flexible. If you need to adjust your payment amount in a given month, just let us know.
Frequently Asked Questions About Medicaid Dental Coverage
Does Medicaid Cover Cosmetic Dentistry?
No. Medicaid covers treatment that's necessary for oral health and function, not treatment that's purely cosmetic. So teeth whitening, cosmetic bonding just for appearance (not to repair damage), and veneers are not covered. However, if you have a tooth that's damaged and needs restoration, and that restoration happens to look better than the original, it's still covered because the purpose is function, not cosmetics.
Can I Use Medicaid Benefits to Pay for Part of a Cosmetic Procedure?
Sometimes. If you're getting a smile makeover that includes both functional and cosmetic components, Medicaid might cover the functional parts. For example, if you need fillings to repair cavities, Medicaid covers those. If you also want to whiten your teeth at the same time, Medicaid doesn't cover the whitening, but you could pay out of pocket for that while Medicaid covers the fillings.
Does Medicaid Cover Orthodontics (Braces or Invisalign)?
Coverage varies by plan and by age. Children often have more comprehensive coverage, including orthodontics. Adults have more limited coverage. Some plans don't cover orthodontics at all. You'll need to verify your specific coverage with our billing team.
Do I Need a Referral to See a Dentist?
No. Medicaid dental is usually open access, meaning you can see any participating dentist without a referral. You don't need to get permission from a primary care doctor first.
Can I Change Dentists?
Yes. If you're not happy with your dentist, you can switch to another participating dentist. Just bring your Medicaid card to your new dentist and they'll verify coverage.
What If My Dentist Refuses to Accept Medicaid?
Some dentists don't accept Medicaid because of the lower reimbursement rates and the administrative burden. Veda Family Dentistry has been accepting Medicaid for years because we believe in making quality dental care accessible. If you find a dentist you like who doesn't accept Medicaid, ask if they might be willing to work with you. Some dentists who don't normally accept Medicaid will for certain patients.
Real Patient Scenarios: How Medicaid Helped
David's Story: From Extraction to Implant
David lost a tooth due to decay. He had Medicaid and couldn't afford an implant. His extraction was covered by Medicaid (he paid $100 out of pocket for the 50% that was his responsibility). For years, he lived with the missing tooth.
Then David saved up some money and asked about implants. We explained that Medicaid doesn't cover implants, but we could help with financing. We set up an in-house payment plan for $250 per month. David's total implant cost was $6,500. Over the course of 26 months, he paid off the implant while still using Medicaid for his regular cleanings and other necessary treatment.
Three years later, David has a beautiful implant that's indistinguishable from his natural teeth. "Medicaid covered the extraction, and then we figured out how to finance the implant," David says. "If we'd just looked at what Medicaid covered, I'd still be missing that tooth."
Rosa's Story: Medicaid Made Preventive Care Possible
Rosa works two part-time jobs and qualified for Medicaid because her income was below the threshold. Before she had Medicaid, she couldn't afford dental care and hadn't been to a dentist in five years. She had cavities, gum disease, and was terrified she'd lose her teeth.
With Medicaid, her preventive cleanings, exams, and X-rays were fully covered. She came in every six months for cleanings. When cavities were found, they were caught early and easily treated (Medicaid covered 60% of the filling cost, and she paid $30 per filling out of pocket). Her gum disease was treated with scaling and root planing (Medicaid covered 60%, she paid about $150).
Two years later, Rosa's teeth are healthy, her gum disease is under control, and she's maintained her teeth through preventive care. "If it wasn't for Medicaid covering preventive care, I would have lost teeth by now," Rosa says. "Now I take care of my teeth and I know I can afford to keep them."
Marcus's Story: Understanding the Bridge vs. Implant Question
Marcus had a missing tooth and wanted to know his options. His Medicaid plan covered bridges at 50%. A bridge would cost $3,500, so his Medicaid would cover $1,750, and he'd pay $1,750. An implant would cost $6,500 and wasn't covered by Medicaid.
We explained the pros and cons of each. A bridge would be done quickly (two appointments) and mostly covered by Medicaid. An implant would take longer (6+ months for bone to integrate after extraction) and would require out-of-pocket financing.
Marcus chose the bridge because it was faster and more affordable upfront. Two years later, his bridge is working great. "For my situation, the bridge was the right choice," Marcus says. "But I appreciate that Dr. Moosavi gave me all the options and explained the pros and cons of each. I made an informed decision."
Strategies for Getting the Most from Your Medicaid Dental Benefits
Now that you understand how Medicaid works, here are some strategies for maximizing your benefits.
Use Your Preventive Benefits Fully
Medicaid covers preventive care at 100%, so take full advantage. Come in twice a year for cleanings and exams. Preventive care catches problems early, when they're cheaper and easier to treat. One cavity caught and treated early is far less expensive than allowing it to progress to the point where the tooth needs a root canal or extraction.
Address Problems Early
As soon as you notice a problem, call us. A small cavity caught early might cost $100 to $200 to fill. The same cavity left untreated might progress to the point where it needs a $1,000 root canal. Early treatment costs less and saves your teeth.
Maintain Excellent Home Care
The more diligent you are about brushing, flossing, and limiting sugary foods, the fewer cavities and gum problems you'll have. This reduces treatment costs overall.
Ask About Coverage Before Treatment
Never assume you know what's covered. Always ask our billing team to verify coverage before you agree to treatment. They'll tell you exactly what Medicaid covers and what you'll pay out of pocket. No surprises.
Explore All Treatment Options
When you have multiple treatment options, ask about the cost of each and what Medicaid covers for each. For example, if a tooth can be saved with a root canal or extracted, you'll want to know the out-of-pocket cost of each option. Sometimes the less obvious choice is the most affordable.
Consider Long-Term Value
Sometimes the treatment with the highest upfront cost offers better long-term value. For example, an implant costs more than a denture, but lasts much longer and requires less maintenance. If you can finance the implant, it might be worth it.
Combining Medicaid with Other Resources
Medicaid Plus CareCredit: The Winning Combination
For many procedures, using Medicaid plus CareCredit financing gives you the best of both worlds. Medicaid covers what it covers, you handle your out-of-pocket portion with CareCredit financing, and you end up with the treatment you need at an affordable cost.
Emergency Medicaid
If you're not currently on Medicaid but have a dental emergency, you might qualify for emergency Medicaid. Emergency Medicaid covers urgent treatment only, not routine care. If you're in severe pain from an abscess or infection, emergency Medicaid might cover the emergency treatment. Call our office to discuss your situation.
Free Clinics and Community Resources
Beyond Medicaid, some communities offer free dental clinics for low-income individuals. Veda Family Dentistry occasionally participates in free dental outreach events. Call us to ask about upcoming opportunities.
Schedule Your Medicaid Dental Visit Today
If you have Medicaid and haven't had a dental checkup recently, now is the time to take advantage of your benefits. Preventive care is fully covered, and our billing team will handle all the paperwork.
Call Veda Family Dentistry to schedule your Medicaid dental appointment. Tell us you have Medicaid, and our billing team will verify your coverage before your appointment so you know exactly what to expect.
You can also book online at your convenience. When you book, select "Medicaid" under insurance type.
At your first appointment, we'll do a comprehensive exam, take X-rays, and discuss any treatment you might need. We'll explain what your Medicaid covers and what your out-of-pocket costs will be. We'll discuss all your options, including financing for procedures Medicaid doesn't cover.
Medicaid is a valuable benefit. Make sure you're using it to keep your teeth healthy for life. Let's get you scheduled today.
“I’ve never felt so comfortable at a dental office. Everyone here truly cares and takes the time to explain everything clearly.”
Maria Alvarez
Teacher
