Using Medicaid Dental Coverage in Virginia: A Practical Guide

Many families in Northern Virginia have dental coverage through Medicaid or FAMIS and aren't sure what it includes, or whether they can find a dentist who accepts it. Zen Family Dental accepts VA Medicaid and DentaQuest, and our team is happy to help you understand your benefits. Here's a practical overview.

Who has dental coverage

In Virginia, dental benefits for Medicaid and FAMIS members are administered by DentaQuest. Coverage includes:

• Children and teens enrolled in Medicaid or FAMIS
• Pregnant members
• Adults enrolled in Medicaid, who gained comprehensive dental benefits in 2021

If you're not sure whether you're enrolled or what plan you have, check your member card or contact your plan. Our team can also verify your eligibility before your visit.

What's typically covered

Exact benefits depend on your age and coverage, and they can change, so always confirm with the plan or with us. In general:

For children and teens

• Exams, cleanings and X-rays
• Fluoride treatments and dental sealants
• Fillings and extractions
• Treatment for dental pain and infection
• Orthodontic treatment in some cases when it's medically necessary (prior approval is required)

For adults

• Exams, cleanings and X-rays
• Fillings and extractions
• Treatment for gum disease, such as deep cleanings
• Root canals, crowns and dentures in many cases, sometimes with prior approval

Some treatments, especially cosmetic procedures such as whitening, generally aren't covered.

How to make the most of your benefits

• Keep up with checkups. Preventive visits are the foundation of your coverage and catch problems while they're small and simpler to treat.
• Bring your member ID card to every visit, along with a photo ID.
• Tell us about changes to your address, phone number or coverage, so your eligibility stays current.
• Renew on time. Medicaid coverage must be renewed periodically. Watch your mail and respond to renewal notices so your coverage doesn't lapse.
• Ask about prior approvals. Some treatments need approval before they're done. We'll handle the paperwork and let you know what to expect.

What to expect at your first visit

Your first visit includes a review of your health history, any X-rays that are due, a full exam and, in most cases, a cleaning. Dr. Kour will explain what she finds and which treatments your coverage includes, so there are no surprises before any work begins.

Start children early

Children's first dental visit should happen by their first birthday or within six months of the first tooth, and Medicaid and FAMIS cover these early visits. Good habits and early checkups prevent most childhood cavities. Our guide to your child's first dental visit explains what happens.

Language should never be a barrier

Our team speaks English, Spanish, Hindi, Urdu and Punjabi. We can explain your benefits, treatment options and costs in the language you're most comfortable with.

What if something isn't covered?

If you need treatment that isn't covered, we'll explain the cost before anything is done, and you can decide what's right for you. Financing through CareCredit and Cherry may help with out-of-pocket costs.

Book your visit

Zen Family Dental welcomes VA Medicaid and DentaQuest members of all ages. See the full list of plans we accept on our new patient and insurance page, then request an appointment online or call (703) 385-2772. We'll verify your benefits before your visit.