Does NC Medicaid Cover Dentures or Dental Implants? What Durham Adults Should Know

If you have NC Medicaid and you are missing teeth, two questions usually come first. Will Medicaid pay for dentures? Will it pay for dental implants?

North Carolina publishes the answer in its own dental policy. For adults who meet the criteria, the policy includes complete and partial dentures, with limits. It lists implant services as not covered. This article walks through what the policy says, what it does not promise, and how Local Start Dental in Durham fits in.

Where these rules come from

NC Medicaid sets out its dental rules in Clinical Coverage Policy 4A, Dental Services. Everything below comes from the version amended December 15, 2023, which was the version posted on the NC Medicaid website when this article was written.

Policies change, and every person's coverage is decided by NC Medicaid. Before you plan treatment around anything here, confirm your own coverage with NC Medicaid.

Complete dentures under NC Medicaid

A complete denture replaces all of the teeth in one arch, meaning your upper or lower jaw. For adults, Policy 4A says:

• Only one denture, complete or immediate, is allowed per arch every 10 years.

• Complete dentures need prior approval. The policy puts that step on the dental provider, who requests approval before treatment. Having Medicaid does not mean a specific denture is already approved.

• The payment for a complete denture includes any adjustments or relines needed during the six months after the denture is delivered.

• After that, the policy allows later relines once every five years.

The 10-year limit is the rule to check first. If Medicaid has already paid for a denture on the same arch within that window, ask about it before you assume a new one is covered. The policy has a separate process for dentures that were lost or stolen, which asks for supporting documents such as a police report.

Partial dentures under NC Medicaid

A partial denture fills gaps when some natural teeth remain. For adults 21 and older, Policy 4A lists these situations:

• Any missing front teeth (incisors or canines)

• Four missing back teeth in the same arch

• Three missing back teeth next to each other in the same arch

Missing third molars (wisdom teeth) do not count toward those numbers. The policy allows one partial denture per arch every eight years, and partial dentures also need prior approval.

For more on how partials work, see types of partial dentures and how to care for them.

Dental implants are not covered

Policy 4A lists implant services as not covered by Medicaid. That includes a single implant that replaces one tooth. It also affects snap-in and fixed implant dentures, because those dentures are held in place by implants.

If an implant is the right treatment for you, Medicaid is not the path to it. These are the options to ask about instead:

• Sliding scale fees. Local Start Dental sets fees on a sliding scale for qualifying patients, based on an application and proof of household income. How to pay for dental care without insurance in Durham explains how it works.

• Financing. Payment plans are available through Proceed Finance, CareCredit, Alpheon Credit, Healthcare Finance Direct, Lending Club and One Main Financial.

• A SIDE training course. SIDE is Local Start Dental's training center for dentists. Patients in its courses receive implant treatment from licensed, practicing dentists, supervised in real time by experienced mentors. See how to become a SIDE patient.

To compare options and pricing, see dental implants in Durham and implant-supported dentures in Durham. Two earlier guides also cover this ground: affordable dental implants in North Carolina without insurance and finding affordable dental implants.

Using NC Medicaid at Local Start Dental

Local Start Dental is a nonprofit clinic at 370 Jackson Street in Durham. Our fees page says the office gladly accepts NC Medicaid that includes the appropriate dental coverage. The clinic focuses on tooth replacement, including dentures in Durham.

If Medicaid does not cover what you need, or you are inside a replacement limit, the fees page lists a removable denture at $566 to $1,375 per arch. Qualifying patients can also apply for sliding scale fees. For a wider look at denture pricing, see how much dentures cost, and for the clinic's charitable care, read about pro bono dental care at Local Start Dental.

For a broader overview of what NC Medicaid includes beyond dentures, see our guide to Medicaid dental coverage in North Carolina.

Questions to ask before you start

• Is my NC Medicaid coverage active, and does it include dental?

• Has Medicaid paid for a denture on this arch in the last 10 years, or a partial in the last eight?

• Will my treatment need prior approval, and what happens while it is being reviewed?

• If part of my treatment is not covered, which payment options apply to me?

Getting started in Durham

If you are not sure where you stand, a phone call is the quickest way to find out. The team can tell you what applies to your situation.

Local Start Dental370 Jackson Street, Durham, NC 27701919.569.5533

Schedule an exam online or contact us with your questions.

This article summarizes NC Medicaid's published dental policy for general information. It is not insurance or legal advice and does not guarantee coverage. NC Medicaid decides eligibility and approval.

The information provided in this article is for educational purposes only and should not be considered medical advice. Every patient's situation is unique, and treatment recommendations may vary based on individual circumstances, medical history, and oral health conditions.

Only a qualified dental professional can determine appropriate treatment after a thorough examination and consultation.

The content on this page is not intended to diagnose, treat, cure, or prevent any dental condition. Always seek the advice of qualified healthcare providers regarding any questions you may have about oral health treatments.

Local Start Dental's fee schedules, financing options, and sliding scale programs are subject to change and qualification requirements. Contact our office directly for current eligibility information.

Individual results may vary, and there are risks associated with any surgical procedure.

Fees shown in this article are current as of the publication date and are subject to change. See our fees page for current pricing. Eligibility for sliding scale fees and for financing is determined by application.