MassHealth Insurance
New MassHealth Adult Dental Annual Maximum
Effective August 1, 2026, MassHealth members age 21 and older (except DDS clients) have a $1,750 annual maximum for covered dental services. Members under 21 and adults who are DDS clients are not affected.
MassHealth Dental Insurance Plans
Smiley Dental Boston is proud to care for MassHealth members at our Roslindale office. Whether you’re looking for a dentist for yourself, your children, or a family member with special care needs, our team checks your coverage, explains what’s included, and handles the paperwork. Dental care covered by MassHealth is available if you’re enrolled in MassHealth Standard, CommonHealth, Family Assistance, CarePlus, MassHealth Limited (emergency services only), or the Children’s Medical Security Plan. You can also view all the insurance plans we accept.
Important update for adults: Beginning August 1, 2026, MassHealth adult dental benefits for members age 21 and older (other than DDS clients) include an annual maximum of $1,750 per benefit year. Your covered services and benefits have not changed.
How It Works Here
- Eligibility and balance check: Bring your MassHealth ID card and we'll confirm your coverage before your visit. For adults 21 and older, we'll also check how much of your annual maximum is remaining before treatment.
- Plain-language plan: We explain which services are covered and whether any need prior approval.
- We handle the paperwork: Our team submits claims and any prior authorization requests for you.
- Options for uncovered care: If a service isn't covered, including services that are no longer covered once an adult member reaches the annual maximum, we'll explain your options and discuss financing before moving ahead. You are only ever charged for a non-covered service if you agree in writing before it's provided.
How to Apply
Online
Visit Mass.gov/MassHealth and create an account. Follow the steps to apply for health and dental benefits.
By Mail
Download and complete the MassHealth Application (ACA-3) from the website, then mail it to:
MassHealth Enrollment Center (MEC)
P.O. Box 290794
Charlestown, MA 02129-0214
By Phone
Call (800) 841-2900 (TTY: (800) 497-4648) for assistance with enrollment.
In Person
Visit a local MassHealth Enrollment Center for help submitting your documents and completing your application.
Once approved, you’ll receive a MassHealth ID card and can access dental services through the MassHealth Dental Program
MassHealth Adult Dental Annual Maximum: What You Need to Know
Effective August 1, 2026, MassHealth pays up to $1,750 per member, per benefit year, toward covered dental services for adults age 21 and older who are not DDS clients. Your covered services have not changed.
Quick Facts
Annual maximum | $1,750 per member, per benefit year |
Starts | Covered services provided on or after August 1, 2026 |
Benefit year | First year: August 1, 2026 to June 30, 2027. After that: July 1 to June 30 each year. |
Resets | Every July 1. Unused amounts do not roll over. |
Applies to | Members 21 and older on MassHealth Standard, CommonHealth, Family Assistance or CarePlus, and services paid by the Health Safety Net at a hospital or community health center. |
Does NOT apply to | Members under 21, and adults 21 and older who are DDS clients. |
How It Works
- The amount used is what MassHealth actually pays, not our billed fee.
- Claims count in the order they are paid, not by visit date. Pending claims are not counted until they are finalized, so your balance can change.
- If your coverage changes or lapses during the year, the amount used does not reset until July 1.
- Turning 21? The maximum applies to services on or after your 21st birthday, through June 30 of that benefit year.
Services That May Still Be Covered After You Reach the Maximum
Certain services may still be covered, as long as all other MassHealth requirements are met:
- Limited (problem-focused) exams and certain X-rays
- Denture repairs and tooth extractions
- Emergency pain relief, anesthesia, and treatment of surgical complications
- A first-ever complete denture after full-arch extractions (replacement dentures still count toward the maximum)
- Continued orthodontic treatment for members who turn 21 during active, MassHealth-approved treatment
What Happens If You Reach the Maximum?
MassHealth will not pay for further services that are subject to the maximum until your benefits reset on July 1. We will talk with you about your options before treatment, including financing options. A non-covered service can be billed to you only if you knowingly choose to be a private-pay patient and sign a written agreement before the service is provided. We cannot require you to pay privately for services MassHealth covers.
Not sure how much you have left? Call us before your visit, or request an appointment online, and we will check your remaining balance.
Learn more: Insurance plans we accept | MassHealth DDS dentist | Children’s dentistry | Patient financing
Eligibility Requirements
- MUST be a resident of Massachusetts
- Combined household income must be within the prescribed threshold
- Citizenship or Immigration status should be verified
Given below is a current list of procedures that are covered for both adults and children who are enrolled in the following plans: MassHealth CarePlus, MassHealth Family Assistance, MassHealth CommonHealth, or MassHealth Standard. For adults age 21 and older (other than DDS clients), covered services are subject to the $1,750 annual maximum described above.
| Dental Service | MassHealth Standard | MassHealth CommonHealth | MassHealth Family Assistance | MassHealth CarePlus |
| Local Anesthesia | Yes | Yes | Yes | Yes |
| Cavity Arresting | Yes | Yes | Yes | Yes |
| Cleanings | Yes | Yes | Yes | Yes |
| Crowns and Caps | Yes | Yes | Yes | Yes |
| Dentures / partials | Yes | Yes | Yes | Yes |
| Exams | Yes | Yes | Yes | Yes |
| Fillings | Yes | Yes | Yes | Yes |
| Fluoride | Yes | Yes | Yes | Yes |
| Oral Surgery | Yes | Yes | Yes | Yes |
| Root Canal | Yes | Yes | Yes | Yes |
| Sealants | Yes | Yes | Yes | Yes |
| Some periodontal services | Yes | Yes | Yes | Yes |
| X-rays | Yes | Yes | Yes | Yes |
| Annual maximum, adults 21+ (not DDS) | $1,750 per benefit year | $1,750 per benefit year | $1,750 per benefit year | $1,750 per benefit year |
| Annual maximum, members under 21 | None | None | None | None |
Except for 3rd Molars
For members age 21 and older who are not DDS clients, covered services count toward the $1,750 annual maximum, with the exceptions listed in the Annual Maximum section above. No annual maximum applies to members under 21 or to DDS clients.
You can apply for MassHealth Dental coverage online, by mail, or by phone.
Dental services available to children include
- Oral Surgery and Exams
- X-Rays
- Cleaning
- Fluoride
- Sealants
- Braces (upon verification)
- Space maintainers
- Root Canals
- Fillings
- Dentures
- Anesthesia
- Extractions
- Crowns and Caps
- Some Periodontal Procedures
No annual maximum applies to members under age 21.
DDS Members
Adults determined to be Department of Developmental Services (DDS) clients are eligible for all dental services listed for non-DDS adult members AND for any other medically necessary dental services such as the ones mentioned above or any other medically necessary.
Adults who are DDS clients are not subject to the $1,750 annual maximum.
Excluding: Fluoride, sealants, braces, and space maintainers.
MassHealth Limited Plan
Patients subscribed to this plan are ONLY eligible for emergency services only. At Smiley Dental Waltham, emergency care will only be provided to clients with this plan if they are at risk without immediate care. The risks may include serious impairment of bodily function or dysfunction of any part of the body.
Children's Medical Security Plan (CMSP)
This plan is meant for children (under the age of 19) who are Massachusetts residents. Typically, MassHealth CMSP allows for an annual maximum of $750/year at Smiley Dental Waltham including preventive and restorative care. Services such routine cleanings, fluoride treatments, sealants, plaque or stain removal and fillings are covered. However, this may be subject to change depending on the provider's agreed upon insurance plan with MassHealth.
Frequently Asked Questions
Do you accept MassHealth Dental?
What does MassHealth Dental cover?
MassHealth Dental (administered by DentaQuest) covers most preventive and restorative services. Common covered services include exams, cleanings, X-rays, fillings, simple extractions, and dentures. Some procedures like crowns, root canals, or periodontal treatments may require prior authorization. For adults age 21 and older (other than DDS clients), covered services count toward the $1,750 annual maximum.
Are cleanings covered?
Are crowns and root canals covered?
Coverage depends on age and medical necessity. MassHealth often covers these procedures when they’re required to maintain oral health or restore function. Our team will request any necessary prior authorization for you. For adults 21 and older (other than DDS clients), these services count toward the $1,750 annual maximum, so we’ll check your remaining balance before treatment and plan with you.
Are cosmetic treatments covered?
Do you see children and adults with MassHealth?
Yes, we treat patients of all ages, including children, adults, and seniors with MassHealth. Pediatric patients receive comprehensive preventive coverage, and adults have access to a wide range of restorative and medically necessary services. Adults age 21 and older (other than DDS clients) are subject to the $1,750 annual maximum. Members under 21 and DDS clients are not.
Do I need to bring my MassHealth card?
What if I lose my MassHealth card?
Do I need to choose a dentist or can I see any provider?
What is the MassHealth adult dental annual maximum?
Effective August 1, 2026, MassHealth pays up to $1,750 per member, per benefit year, toward covered dental services for eligible adults age 21 and older who are not DDS clients. It is the total amount MassHealth will pay for your covered dental care during the benefit year.
Who does the annual maximum apply to?
It applies to members age 21 and older enrolled in MassHealth Standard, CommonHealth, Family Assistance or CarePlus, as well as individuals whose services are paid by the Health Safety Net at a hospital or community health center. It does not apply to members younger than 21 or to adults who are DDS clients.
When does the annual maximum start, and when does it reset?
It applies to covered services provided on or after August 1, 2026. The first benefit year runs from August 1, 2026 through June 30, 2027. After that, each benefit year runs from July 1 through June 30, matching the Massachusetts state fiscal year rather than the calendar year. Your maximum resets to $1,750 every July 1.
Do unused benefits roll over to the next year?
No. Unused amounts do not roll over. Your annual maximum resets to $1,750 at the start of each benefit year on July 1.
How do I know how much of my annual maximum is left?
Call us before your visit and our team will check your remaining balance for you. Your balance reflects claims that have been finalized and paid, so claims that are still processing are not included yet, and your balance may change as they are completed.
What happens if I reach the annual maximum?
Once you reach it, MassHealth will not make additional payments for covered services that are subject to the maximum for the rest of that benefit year. A few services can still be covered (see below). For other services, we will talk with you in advance about your options, including scheduling, private-pay and financing.
Which services are still covered after I reach the annual maximum?
Certain services may remain covered, as long as all other coverage requirements are met: limited exams, certain diagnostic X-rays, denture repairs, tooth extractions, emergency pain relief (palliative treatment), anesthesia, and treatment of surgical complications. A first-ever complete denture after full-arch extractions is also eligible, as is continued MassHealth-approved orthodontic treatment for members who turn 21 while in active treatment. Replacement complete dentures still count toward the maximum.
Can I be charged for a service after I reach the annual maximum?
Only in limited circumstances. If a service is no longer covered because you have reached the annual maximum, we can only charge you for it if you knowingly choose to receive it as a private-pay patient and sign a written agreement before the service is provided. Without that signed agreement we cannot bill you. Covered services must still be billed to MassHealth, and we cannot require you to pay privately for them.
I'm turning 21. How does the annual maximum affect me?
There is no annual maximum for members under 21. If you are not a DDS client, the $1,750 maximum applies to services provided on or after your 21st birthday, through the end of that benefit year on June 30. It then resets on July 1. If you turn 21 while in active, MassHealth-approved orthodontic treatment, continued orthodontic services may be covered beyond the maximum.
Ready to Check your Benefits?
Call 857-888-8000 and say you have MassHealth. We’ll verify your coverage and, for adults 21 and older, check how much of your annual maximum is remaining.
Other locations: Beverly 978-288-1000 • Lowell 978-999-9000 • Waltham 781-666-6000 • Fairhaven 508-967-1000.
