Smiley Dental accepts dental insurance coverage from MassHealth. Dental services are available to you at Smiley Dental if you are enrolled in the following MassHealth insurance plans: MassHealth Standard, MassHealth CommonHealth, MassHealth Family Assistance, CarePlus, MassHealth Limited (for emergency services only), and Children’s Medical Security Plan.
Eligibility
To determine whether you are eligible for MassHealth insurance, you must fill out an application for eligibility. For further inquiry on completing and submitting this application so you can receive dental care from Smiley Dental, please click this link: MassHealth Insurance Application Portal.
A few general eligibility requirements are
- Financial state. You must be financially stable enough to qualify for the MassHealth insurance plans.
- Residency. You must be a resident of Massachusetts to receive MassHealth benefits.
- Citizenship or immigration Status. Your citizenship or immigration status must be verified in order to receive MassHealth benefits.
There are different types of coverages based on your needs. MassHealth offers different coverages on the following
- If you are a parent living with your children under 19 years of age.
- If you are an adult caretaker relative living with children related to you by blood, marriage, or adoption under 19 years of age.
- If you are a spouse or former spouse of the relative described directly above and you are the primary caretaker of the children when neither parent is home.
- If you are younger than 19 years of age.
- If you are a young adult 19 or 20 years of age.
- If you are an adult 21 through 64 years of age.
- If you are pregnant.
- If you are disabled.
- If you are HIV-Positive.
- If you are a breast or cervical cancer patient.
If you are above 65 years of age and do not meet any of the criteria stated above, click on this link: Eligibility for people 65 years or older. This link will give you further information on your eligibility for MassHealth coverage.
Understanding your benefits
Patients enrolled in the following plans have access to the same dental benefits at Smiley Dental with respect to their age group: MassHealth Standard, MassHealth CommonHealth, MassHealth Family Assistance, and MassHealth CarePlus. Dental services and benefits may vary depending on your employer or group’s agreed-upon insurance plan with MassHealth. Smiley Dental accepts the insurance plans listed above and complies with the benefits and restrictions determined by MassHealth. First, children and adults do not receive all of the same benefits even in the same plan. Second, adults who are determined by the Department of Developmental Services (DDS) to be DDS clients receive different services than non-DDS clients. Third, to have dental services covered at Smiley Dental, before receiving the service, the service must be deemed as medically necessary for you by your provider.
To understand the typical discrepancies between children’s and adult’s access to benefits at Smiley Dental, please see below.
Dental services covered for children (members under 21 years of age)
- Anesthesia (general, nitrous, intravenous, and non-intravenous)
- Braces (must have prior authorization)
- Cavity arresting medicament
- Cleanings
- Crowns/caps
- Root canal treatments (not on third molars)
- Deep Cleaning
- Dentures/partials/plates
- Temporary denture
- Tooth-removal
- Fillings
- Fluoride
- Oral exams
- Sealants
- Oral surgery
- Space maintainers
- Some periodontal service
- X-rays
- Other medically necessary dental services (must have prior authorization)
Dental services covered for adults (members 21 years of age or older)
- Anesthesia (general, nitrous, intravenous, and non-intravenous)
- Cavity arresting medicament
- Cleanings
- Crowns/caps
- Dentures/partials/plates
- Tooth removal
- Fillings
- Fluoride
- Oral exams
- Oral surgery
- Root canal treatments
- Some periodontal service
- Deep cleaning (prior authorization is needed)
DDS Members
Adults who are determined to be DDS clients typically have access to the dental services listed above for non-DDS members as well as access to other medically necessary dental services. These are the typical services that DDS members have access to; however, these services may differ depending on your provider’s agreed-upon insurance plan with MassHealth.
What is prior authorization?
Certain services listed above specify that you must have prior authorization before receiving the services. This means that your provider may need to send a request to DentaQuest or directly to MassHealth in order for determination on whether that service is deemed necessary. If it is approved by MassHealth or DentaQuest then you may receive the service. This is not to be confused with confirming that services are medically necessary as stated above. To reiterate, at Smiley Dental, before receiving any dental care you must contact your provider and your provider must confirm that the service is medically necessary in order to be compensated.
MassHealth Limited Members
MassHealth Limited typically covers emergency services only. At Smiley Dental, dental services can only be received with this plan if your health would be at jeopardy without immediate care. This includes serious impairment to bodily function or developmental dysfunction of any bodily organ or part. To learn more about the MassHealth Limited Plan, please contact MassHealth Customer Service at (800) 841-2900.
Children’s Medical Security Plan
The Children’s Medical Security Plan (CMSP) is accepted by Smiley Dental. Typically, the MassHealth CMSP allows for an annual maximum of $750/year at Smiley Dental including preventive and restorative services. Services such as plaque or stain removal, routine cleanings, fluoride treatments, sealants, and fillings are covered. However, this may be subject to change depending on your provider’s agreed upon insurance plan with MassHealth. To learn more about your CMSP at MassHealth please contact MassHealth Customer Service at (800) 841-2900.
