What Is the Medi-Cal Dental Program?
What Is the Medi‑Cal Dental Program?
The Medi‑Cal Dental Program is the name of Medi‑Cal’s dental benefit offered to enrolled Medi‑Cal members. Your Medi‑Cal benefits and your child’s Medi‑Cal benefits include free or low-cost dental coverage. If your income is more than the Medi‑Cal limits for your family size, a low-cost monthly premium is required.
What If I live in Sacramento or Los Angeles County?
How can I obtain information about my benefits if I have a managed care dental plan?
If you live in Sacramento County, you will need to enroll in Dental Managed Care (DMC) and will see a dentist through a dental managed care plan. If you live in Los Angeles County, you can choose to remain in Medi‑Cal Dental or enroll in DMC. If you enroll in DMC, the plan you choose will send you information about your benefits.
Do I Qualify?
Do I qualify for Medi‑Cal dental services?
The Medi‑Cal program offers a variety of benefits to members including covered dental services. To receive dental coverage through Medi‑Cal, you must be Medi‑Cal eligible. Your eligibility determines the types of benefits you have access to through Medi‑Cal. You do not need to apply separately for dental coverage because it is a part of the Medi‑Cal program.
How do I apply for Medi‑Cal to get dental services?
For information on how to apply for Medi‑Cal, please visit www.coveredca.com or you can call 1‑800‑300‑1506.
What Am I Covered For?
What dental services am I covered for?
The Medi‑Cal program offers benefits to members including dental services. You do not need to apply separately for dental coverage because it is a part of the Medi‑Cal program.
If I am signed up, do I have to pay for dental services?
The Medi‑Cal Dental Program covers dental services for most Medi‑Cal members. Depending on your income for your family size, dental services may be at no cost to you (or your child). In some cases, you may have to pay a “Share of Cost (SOC)” and/or a co-pay.
What does the Medi‑Cal Dental Program pay for?
The Medi‑Cal Dental Program covers many services to help keep your gums and teeth strong and healthy.
What is a Share of Cost (SOC)?
In some cases, you may have to pay a Share of Cost (SOC) and/or a co-pay as a Medi‑Cal member. SOC is determined according to your monthly income. If you have been told that you have a SOC, this likely means your income is more than the Medi‑Cal limit for your family size, and you have to pay a monthly dollar amount for your medical expenses.
Contact Medi‑Cal at 1‑800‑541‑5555 to find out what your share of the cost is.
What is a Co‑Pay?
Your co‑pay is a fixed amount you pay for a service, usually at the same time you receive the service. The co‑pay usually falls outside your covered dental services. The amount can vary by the type of service. For example, a dental visit might have a co-pay of $2. The co‑pay for an emergency room visit will usually cost more. For some services, you may have a co-pay and a SOC.
The following services may have a co‑pay for adults with your Medi‑Cal dental benefit:
- Non-emergency services provided in an emergency room – Co‑pay $5
- Outpatient services – Co‑pay $1
What is EPSDT?
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
If you or your child are under 21 years old, Medi-Cal covers preventive services, such as regular health check-ups and screenings. Regular checkups and screenings look for any problems with your medical, dental, vision, hearing, and mental health, and any substance use disorders. You can also get vaccinations to keep you healthy. Medi-Cal covers screening services any time there is a need for them, even if it is not during your regular check-up. All of these services are at no cost to you.
For details, please view the Information for Medi-Cal Beneficiaries (EPSDT) document.
How Do I Find a Medi-Cal Dentist?
How do I find a Medi-Cal dentist?
You can find a dentist by visiting the Medi‑Cal Dental provider website, or you can call the Telephone Service Center Phone Line at 1‑800‑322‑6384.
What if I want a second opinion?
As Medi‑Cal member, you can request another dentist or specialist to see you before making a decision about your primary dentist’s treatment plan for you. This is also available to you if you are enrolled in a DMC plan.
If I do not have a ride, are there other options to get to the dentist’s office?
Medi‑Cal provides non-emergency and non-medical transportation services to eligible members. Your dentist must prove that your appointment is medically necessary. Once the dentist has received approval that your visit is medically necessary, you can then request transportation from your home to your dental visit.
For transportation assistance, call the Telephone Service Center Phone Line at 1‑800‑322‑6384. The transportation must be used only for necessary health care covered by the Medi-Cal program.
Call your county social services office for help if you need a ride to your appointment and if you don’t qualify for medically necessary non-emergency transportation services.
What do I need to bring to my dental appointment?
Show your Medi‑Cal Benefits Identification Card (BIC) to your dentist whenever you receive dental care. Your dentist will match the name and signature on your BIC with another form of identification, such as:
- Your Social Security Number (SSN)
- A valid California driver’s license
- Any identification card issued by the Department of Motor Vehicles (DMV)
- Or any other document which appears to prove your identity
Under special instances, you can still be seen for dental services without a BIC. If your dentist does not know you, they are required to make a good faith effort to verify your identity.
What happens if I miss an appointment?
It is important to show up at your dentist appointments. However, if you know you will not be able to make it, your dentist will appreciate you calling 24-hours in advance to cancel and reschedule.
Missing a dental appointment can have a big impact on the health of your mouth and can be costly. Let’s say you missed an appointment during which you might have found out you had a small cavity. By missing that appointment, the unchecked cavity will get worse and may lead to a root canal instead of just a filling.
It is best to make all necessary arrangements (transportation, babysitting, time off work) when you first schedule your appointment so that you are more likely to keep it.
What is an authorized representative?
An Authorized Representative is someone you can name and give access to your Protected Health Information (PHI). An Authorized Representative can be family members, friends, or any other individual you choose. For example, you may want your spouse or adult child to help with billing questions, booking appointments, or to be aware of your health status. See our Member Authorized Representative Frequently Asked Questions for more information.