If you’re missing one or more teeth, you may have considered dental implants as a solution to restore your smile.
Dental implants are a popular and effective way to replace missing teeth, but the big question on many people’s minds is whether their Oregon Health Plan (OHP) covers the cost of dental implants.
In this blog by Dental Implants Guide, we will explore the topic and provide you with all the information you need to know about OHP coverage for dental implants.
Related Article ➦ What Makes Dental Implants Medically Necessary?
What is OHP (Oregon Health Plan)?
The Oregon Health Plan, or OHP, is a Medicaid program that provides low-income Oregonians with health insurance.
OHP provides coverage for a wide range of dental services, including preventive care, basic restorative care, and emergency care.
Does OHP Cover Dental Implants?
While OHP typically does not cover dental implants, there are some exceptions.
1. Children ➜ OHP covers dental implants for children under specific circumstances. If a child has a congenital condition or loses teeth due to an accident, OHP may cover the cost of dental implants.
2. Medically Necessary Cases ➜ In some cases, when a dental implant is considered medically necessary, OHP may provide coverage. For example, if you’ve lost teeth due to oral cancer or a severe accident, OHP might consider covering the procedure.
3. Limited Coverage for Pregnant Women ➜ Pregnant women with OHP coverage may have limited dental benefits, which could include coverage for dental implants if deemed medically necessary.
How to Get Dental Implants Covered by OHP?
Understanding your OHP dental coverage can sometimes feel like a maze, but don’t worry; you’re not alone. Here are some steps to help you navigate OHP dental coverage:
Step 1: Verify Your OHP Plan ➜ Make sure you know which OHP plan you are enrolled in, as this will affect your dental benefits.
Step 2: Find an OHP Dentist ➜ Look for a dentist who accepts OHP. Your OHP plan’s website or customer service can provide you with a list of in-network dentists.
Step 3: Consult with Your Dentist ➜ Schedule a consultation with your chosen dentist to discuss your dental needs and the potential need for dental implants.
Step 4: Check Eligibility ➜ If you’re considering dental implants, check with your dentist and OHP to see if you meet the eligibility criteria.
Step 5: Obtain Prior Authorization ➜ If required, work with your dentist to obtain prior authorization from OHP for the dental implant procedure.
Step 6: Review Your Plan ➜ Carefully review your OHP dental plan to understand what services are covered and any associated costs or copayments.
Step 7: Plan Your Treatment ➜ Once you have all the information, work with your dentist to plan your dental implant treatment.
Step 8: Follow Through ➜ Attend all scheduled appointments and follow your dentist’s recommendations for aftercare.
Related Article ➦ What are Dental Implants Made Of?
OHP Coverage List
| Category | Services Covered |
|---|---|
| Preventive care | Dental exams, cleanings, fluoride treatments, sealants |
| Basic restorative care | Fillings, crowns, bridges, root canals |
| Emergency care | Pain relief, treatment of infections, and other urgent dental needs |
| Other services | X-rays, dentures, orthodontics (for children under the age of 19) |
FAQs
What is OHP?
OHP stands for Oregon Health Plan. It’s a program that helps people get healthcare, including dental care.
Can I get dental implants through OHP?
It depends on your specific OHP plan, so you’ll need to check with them.
How do I know if I have dental coverage with OHP?
Look at your OHP card or contact OHP customer service to find out.
How can I apply for OHP dental coverage?
You can apply online through the Oregon Health Authority website or get help at a local office.
Are there income limits for OHP dental coverage?
Yes, your household income must be at or below 400% of the Federal Poverty Level (FPL).
Final Thoughts
The amount to which your OHP plan covers dental implants is determined by a variety of factors, including your specific OHP plan, your dental health, and the medical necessity of the procedure. To navigate the process effectively, you must work closely with your dentist and OHP.
If you have any further questions or require assistance with your OHP dental coverage, please contact OHP customer service or a knowledgeable dentist.
