Medicaid Dentist

At Prime Smile, we practice a philosophy that ensures all patients’ needs are met; including the lower income families across Indianapolis. No matter your financial situation, your children will have access to high quality dentistry.

Prime Smile is a Medicaid Dentist. In fact, a majority of our patients utilize Medicaid to receive their dental care. As a family dentistry, we are happy to accept Medicaid for the whole family! For pediatric dentistry and adult dentistry, look no further than Prime Smile.

To find more information about Medicaid in Indiana, click here.

Medicaid for Children in Indiana

Dental coverage for children is significantly more comprehensive in Indiana than it is for adults. Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Under EPSDT, children dental services for children must minimally include: relief of pain and treatment of infections, restoration of teeth, and regular maintenance of dental health.

EPSDT also requires that all services must be provided if determined medically necessary.
For more information on EPSDT and the benefits entitled to children, visit the Medicaid dental page here.

States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. For more information, see CHIP Dental Care Goals.

Does Medicaid Cover the Full Cost of my Dental Visit?
Yes, Medicaid covers the entirety of your dental work costs. This only applies to the services covered under state laws. For adults, annual exams and preventative care are covered. Children are entitled to more coverage than adults, as dictated by EPSDT.
You may still be required to pay a co-pay cost for your visit.

Does Scheduling Work Differently with Medicaid?
No, we still try to provide same-day care to all of our patients, even if they are covered under Medicaid. At Prime Smile, professionalism is at the core of everything we do.

Can Medicaid Cover Cosmetic Dentistry?
No, as Prime Smile does not offer cosmetic dentistry, such as veneers or bleaching, to our patients.

Is Prime Smile a Registered Participating Medicaid Dentistry?
Yes, Prime Smile is listed as a participating Medicaid dentistry on all of the required sites.

Can I See the Details of the Indiana State Benefits Package?
States are required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on www.insurekidsnow.gov. You can find Indiana’s benefits package here.

Hoosier Healthwise is a health care program for children up to age 19 and pregnant women. The program covers medical care such as doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost to the member or the member’s family.

The Children’s Health Insurance Program (CHIP) falls under the Hoosier Healthwise program. CHIP is for children up to age 19 whose families have slightly higher incomes. In CHIP, members are required to pay a low monthly premium for coverage as well as copays for certain services.

There are two benefit packages within Hoosier Healthwise:

• Package A – This is a full-service plan for children and pregnant women. Members do not have any cost-sharing obligations.
• Package C – This is a full-service plan for children enrolled in CHIP. There is a small monthly premium payment and co-pay for some services based on family income.

For a general description of the benefits and services under these benefit packages, refer to the Indiana Medicaid Covered Services page.

• For eligibility information, including income requirements, for Hoosier Healthwise-Package A, refer to the eligibility guide.
• For eligibility information, including income requirements, as well as premium and copay information for Package C, refer to the premium payments page.
• You can find information about the program within the Hoosier Healthwise brochure.
• When you enroll with Hoosier Healthwise, you must select a health plan. You may choose among the following:
  • Anthem
  • CareSource
  • Managed Health Services
  • MDwise
• You can visit the Working With Your Health Plan page to select the best health plan for you. You can also find a summary of the Hoosier Healthwise health plans.
• Once you have selected a health plan, you will be asked a series of questions about your health care. These questions will allow the health plan to understand your needs so that they may provide you with all the services you need. If you have extra needs, the health plan will ask you specific questions to better understand your healthcare treatment.
• If you have questions about your benefits or your coverage, you should contact your health plan or the Indiana Medicaid enrollment broker, Maximus. You can find the phone numbers on the contact Indiana Medicaid webpage.