Does My NC Medicaid Health Plan Cover Dental?
No. Your NC Medicaid health plan doesn't decide your dental coverage. In North Carolina, NC Medicaid covers dental directly, so your dental benefits are the same no matter which plan name is on your card, and you can see any dentist who takes Medicaid.
Why your health plan isn't part of it
Your health plan handles a lot of your care, like doctor visits and prescriptions. Dental is one of a few services NC Medicaid kept for itself. It calls these "carved-out" services, which means NC Medicaid pays for them instead of your health plan. Its fact sheet on carved-out services lists dental as one of them and says you can get these services from any provider who takes Medicaid.
That means the plan name on your card doesn't change what dental treatment is covered, and it doesn't limit which dental office you can go to.
Which plans this applies to
Dental works the same way under every NC Medicaid plan:
Standard Plans: AmeriHealth Caritas, Carolina Complete Health, Healthy Blue and UnitedHealthcare Community Plan
Tailored Plans: Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health
The Children and Families Specialty Plan (Healthy Blue Care Together)
The EBCI Tribal Option
NC Medicaid Direct
If you had WellCare, that plan became part of Carolina Complete Health on April 1, 2026. Your dental coverage didn't change.
For questions about your dental benefits, call the NC Medicaid Contact Center at 1-888-245-0179, Monday through Friday, 8 a.m. to 5 p.m.
What NC Medicaid covers for dentures and implants
NC Medicaid's dental rules are in its Clinical Coverage Policy 4A. For adults who are missing teeth, these are the parts that matter most:
Complete dentures are covered once per arch (your upper or lower teeth) every 10 years.
Partial dentures are covered once per arch every 8 years, and only when certain teeth are missing.
Dental implants are not covered.
Dentures need prior approval from NC Medicaid before work begins. Your dentist sends that request.
If your current dentures can be repaired or relined to work again, Medicaid won't approve new ones.
We go through these limits in more detail in does NC Medicaid cover dentures or dental implants. For the bigger picture, Medicaid dental coverage in North Carolina and paying for dental care with Medicaid go further.
When the waiting period can be lifted
NC Medicaid will consider replacing dentures before the 8 or 10 years are up in a few situations, as long as you have the paperwork:
They were stolen (a police report)
They were lost in a house fire (a fire report)
They were lost in a hurricane, flood or other natural disaster (paperwork from FEMA or the American Red Cross)
They no longer fit because of a significant medical condition (a letter from your doctor and one from your dentist)
NC Medicaid makes the final call on your coverage, so confirm yours before you plan treatment around it.
Using your Medicaid in Durham
We accept NC Medicaid when your coverage includes dental. Because dental is carved out, the plan on your card doesn't affect whether we can see you. Dentists who take Medicaid in Durham explains how to check whether a practice takes Medicaid, and our dental care in Durham page covers the everyday care we provide.
When Medicaid doesn't cover everything
Sometimes Medicaid covers part of a treatment plan but not all of it, or you're still inside the waiting period for new dentures. You still have options.
If you qualify, our sliding scale sets your cost based on your household income. You apply with proof of income, and how to pay for dental care without insurance in Durham walks through how it works.
We also offer payment plans through CareCredit, Proceed Finance, Alpheon Credit, Healthcare Finance Direct, LendingClub and OneMain Financial. Current pricing is on our fees page.
If you're deciding between dentures and implants, these pages walk through what each one involves: dentures in Durham and dental implants in Durham.
Questions to ask before you start
Is my NC Medicaid active, and does it include dental?
Has Medicaid already paid for a denture on this arch, and when?
Does my treatment need prior approval, and has it been requested?
If part of my treatment isn't covered, what are my options for the rest?
The first question is one for NC Medicaid or your county Department of Social Services, since a few types of Medicaid, like family planning only coverage, don't include dental. We can help you work through the rest.
Where to start in Durham
A phone call is usually the fastest way to find out where you stand. Tell us what's going on and we'll tell you what applies to you.
Local Start Dental 370 Jackson Street, Durham, NC 27701 919.569.5533
You can also schedule an exam online or send us your questions.
This article explains NC Medicaid's published rules in general terms. It isn't insurance or legal advice, and it can't guarantee what your own coverage includes. 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. Eligibility for sliding scale fees and for financing is determined by application.
Individual results may vary, and there are risks associated with any surgical procedure.
