MassHealth Insurance
New MassHealth Adult Dental Annual Maximum
For covered services provided on or after August 1, 2026, MassHealth members age 21 and older (except DDS clients) have a $1,750 annual maximum for dental care. Members under 21 and adults who are DDS clients are not affected.
MassHealth Dental Plans in Beverly
Smiley Dental Beverly is proud to welcome MassHealth members from Beverly and the North Shore. Whether you need a dentist for yourself, a child, or a loved one with special care needs, our team will check your coverage, walk you through your benefits, and take care of the paperwork. We accept MassHealth Standard, CommonHealth, Family Assistance, CarePlus, MassHealth Limited (emergency services only), and the Children’s Medical Security Plan (CMSP). You can also see all the insurance plans we accept.
Good to know for adults: Starting August 1, 2026, MassHealth adult dental benefits for members age 21 and older (other than DDS clients) include an annual maximum of $1,750 per benefit year. The list of covered services has not changed.
What to Expect at Our Office
- Quick benefit check: Bring your MassHealth ID card and we will verify your coverage before you sit in the chair. If you are 21 or older, we will also look at how much of your annual maximum is left.
- Clear explanation: We tell you what is covered, what is not, and which treatments need approval first.
- Paperwork handled for you: Our team sends your claims and any prior authorization requests directly to MassHealth.
- Honest options for non-covered care: If a service is not covered, we will talk through your choices and financing before anything starts. You are only billed for a non-covered service if you agree to it in writing beforehand.
How to Apply for MassHealth Dental
There are four easy ways to apply for MassHealth dental coverage.
Online
Go to Mass.gov/MassHealth, create an account, and complete the application for health and dental benefits.
By Mail
Print the MassHealth Application (ACA-3) from the MassHealth website, fill it out, and send it to:
MassHealth Enrollment Center (MEC) P.O. Box 290794 Charlestown, MA 02129-0214
By Phone
Call (800) 841-2900 (TTY: (800) 497-4648) to speak with someone about enrollment.
In Person
Stop by a MassHealth Enrollment Center and get help with your documents and application.
After you are approved, you will receive a MassHealth ID card and can start using the MassHealth Dental Program.
MassHealth Adult Dental Annual Maximum: What Adults Should Know
For covered services provided on or after August 1, 2026, MassHealth pays up to $1,750 per member, per benefit year for adults age 21 and older who are not DDS clients. The services MassHealth covers have not changed.
Quick Facts
Annual maximum | $1,750 per member, per benefit year |
Start date | Covered services provided on or after August 1, 2026 |
Benefit year | First year runs August 1, 2026 to June 30, 2027. After that, July 1 to June 30 each year. |
Reset date | Every July 1. Unused dollars do not carry over. |
Applies to | Members 21 and older on MassHealth Standard, CommonHealth, Family Assistance, or CarePlus, and services paid by the Health Safety Net at a hospital or community health center |
Does not apply to | Members under 21 and adults 21 and older who are DDS clients |
How the Maximum Is Counted
- The amount counted is what MassHealth actually pays, not the fee we bill.
- Claims are counted in the order they are paid, not the order of your visits. Claims that are still processing are not counted yet, so your balance can shift.
- If your coverage changes or pauses during the year, your used amount stays the same until it resets on July 1.
- If you turn 21 during the benefit year, the maximum applies to services on or after your 21st birthday through June 30.
Services That May Still Be Covered After You Reach the Maximum
When other MassHealth requirements are met, these services may still be covered:
- Limited (problem-focused) exams and certain X-rays
- Denture repairs and tooth extractions
- Emergency pain relief, anesthesia, and treatment of surgical complications
- A first complete denture after full-arch extractions (replacement dentures count toward the maximum)
- Ongoing MassHealth-approved orthodontic treatment for members who turn 21 while in treatment
If You Reach the Maximum
Once you use the full $1,750, MassHealth will not pay for additional services that fall under the maximum until your benefits reset on July 1. Before any treatment, we will go over your options with you, including patient financing. We can only bill you for a non-covered service if you choose to be a private-pay patient and sign a written agreement before the service is provided. We cannot ask you to pay privately for a service MassHealth covers.
Wondering how much you have left? Call our Beverly office before your visit or request an appointment online and we will check your remaining balance.
Related pages: Insurance plans we accept | MassHealth DDS dentist | Children’s dentistry | Patient financing
Who Qualifies for MassHealth Dental?
The only way to confirm eligibility is through a MassHealth application, but these are the basics:
Eligibility can also depend on your age, disability status, pregnancy, or enrollment through programs like the Department of Developmental Services (DDS).
The table below shows the dental services covered for children and adults on MassHealth Standard, CommonHealth, Family Assistance, and CarePlus. For adults 21 and older (other than DDS clients), covered services count toward the $1,750 annual maximum.
|
Dental Service |
MassHealth Standard |
MassHealth CommonHealth |
MassHealth Family Assistance |
MassHealth CarePlus |
|---|---|---|---|---|
|
Local Anesthesia |
Yes |
Yes |
Yes |
Yes |
|
Cavity Arresting |
Yes |
Yes |
Yes |
Yes |
|
Cleanings |
Yes |
Yes |
Yes |
Yes |
|
Crowns and Caps |
Yes |
Yes |
Yes |
Yes |
|
Dentures / Partials |
Yes |
Yes |
Yes |
Yes |
|
Exams |
Yes |
Yes |
Yes |
Yes |
|
Fillings |
Yes |
Yes |
Yes |
Yes |
|
Fluoride |
Yes |
Yes |
Yes |
Yes |
|
Oral Surgery |
Yes |
Yes |
Yes |
Yes |
|
Root Canal |
Yes |
Yes |
Yes |
Yes |
|
Sealants |
Yes |
Yes |
Yes |
Yes |
|
Some Periodontal Services |
Yes |
Yes |
Yes |
Yes |
|
X-rays |
Yes |
Yes |
Yes |
Yes |
|
Annual maximum, adults 21+ (not DDS) |
$1,750 per benefit year |
$1,750 per benefit year |
$1,750 per benefit year |
$1,750 per benefit year |
|
Annual maximum, members under 21 |
None |
None |
None |
None |
*Except for 3rd Molars
Dental Care for Children and Teens (Under 21)
Kids and young adults under 21 get the widest range of dental benefits under MassHealth, and there is no annual maximum. Covered care can include:
- Exams, cleanings, and fluoride
- Sealants
- X-rays
- Fillings and crowns
- Extractions and oral surgery
- Space maintainers
- Sedation or anesthesia when medically necessary
- Braces with prior authorization and proof of medical need
Dental Care for Adults (21 and Older)
Adults can receive medically necessary dental care, including:
- Exams and cleanings
- X-rays and fluoride
- Fillings
- Root canals on eligible teeth
- Crowns when medically necessary
- Extractions and oral surgery
- Full and partial dentures
- Some gum disease treatment with prior authorization
These services count toward the $1,750 annual maximum for adults who are not DDS clients.
DDS Members
Adults who receive services through the Department of Developmental Services (DDS) can access a broader set of dental benefits than other adult members. This includes any medically necessary dental service, not only the services in the table above. DDS clients are not subject to the $1,750 annual maximum. Our team works with families and DDS case managers to keep care organized and stress free. Learn more on our MassHealth DDS dentist page.
Prior Authorization
Some treatments need MassHealth approval before we begin. This most often applies to braces, gum treatment, larger restorative work, and complex oral surgery. You do not have to chase it down. Our administrative team submits the request and updates you along the way.
MassHealth Limited
This plan covers emergency dental care only. That means treatment for severe pain, swelling, infection, or other urgent problems that put your health at risk. Routine visits such as cleanings and fillings are not covered. If you have MassHealth Limited and need help, call our office and we will review what we can do for you. You can also read about our same day emergency care.
Children's Medical Security Plan (CMSP)
CMSP is designed for Massachusetts children under 19. It typically comes with a yearly dental maximum of around $750, and the exact amount depends on your plan and provider agreement. Covered care can include cleanings, fluoride treatments, sealants, and fillings. We will confirm your child’s benefits at their visit.
Frequently Asked Questions
Does Smiley Dental Beverly take MassHealth?
Yes. We accept MassHealth dental plans for children and adults. Our team verifies your benefits, explains your coverage, and files claims on your behalf.
What does MassHealth dental cover?
MassHealth covers most preventive and basic restorative care, including exams, cleanings, X-rays, fillings, extractions, and dentures. Some services, such as crowns, root canals, and gum treatment, may need prior authorization. For adults 21 and older (other than DDS clients), covered services count toward the $1,750 annual maximum.
Are routine cleanings and exams covered?
Yes. Eligible members can generally get a cleaning and exam every six months.
Are crowns and root canals covered?
Often, yes, when they are medically necessary. Our team will submit any prior authorization request for you. Adults 21 and older who are not DDS clients should know these services count toward the annual maximum, so we check your remaining balance first and plan with you.
Does MassHealth cover dental implants?
Implants are generally not a covered benefit. If you are missing teeth, call us and we will go over your plan, other tooth replacement options, and financing.
Does MassHealth cover braces?
Braces are covered only when medically necessary and approved through prior authorization. This is most common for children with significant bite or function problems.
Are cosmetic treatments covered?
No. Cosmetic services such as teeth whitening and veneers are not covered by MassHealth.
Do you treat both children and adults?
Yes. We welcome MassHealth patients of every age, from toddlers to seniors. Members under 21 and DDS clients are not subject to the annual maximum. Adults 21 and older (other than DDS clients) are.
Is emergency dental care covered?
Yes. MassHealth plans cover emergency care for severe pain, swelling, infection, or trauma. Call us right away if you need to be seen.
Do I need a referral from my primary care doctor?
No. You do not need a referral to see a dentist with MassHealth.
Do I need to bring my MassHealth card?
Yes. Please bring your MassHealth ID to every visit so we can confirm your eligibility and benefits.
What if I lose my MassHealth card?
Call MassHealth Customer Service at (800) 841-2900 or log in to your account at mass.gov/masshealth to request a new one.
Can I choose any dentist?
You can see any dentist who participates in the MassHealth Dental Program. Smiley Dental Beverly and our other Massachusetts offices are part of that network.
What is the MassHealth adult dental annual maximum?
It is the most MassHealth will pay for covered dental services for an eligible adult (21 and older, not a DDS client) during one benefit year. The limit is $1,750 and applies to services provided on or after August 1, 2026.
When does the annual maximum reset?
Every July 1. The first benefit year runs from August 1, 2026 through June 30, 2027. Unused dollars do not roll over.
How can I find out how much of my maximum is left?
Call our Beverly office before your appointment and we will check for you. Your balance only reflects claims that are finalized, so it may change as pending claims are processed.
What happens if I reach the annual maximum?
MassHealth stops paying for services that fall under the maximum until July 1. A few services may still be covered, such as extractions, denture repairs, and emergency pain relief. For everything else, we will talk through your options ahead of time, including scheduling and financing.
Can I be charged after I reach the maximum?
Only if you knowingly choose private pay and sign a written agreement before the service. Without your signature, we cannot bill you. Services MassHealth covers must still be billed to MassHealth.
I am turning 21 soon. What changes?
There is no annual maximum before age 21. After your 21st birthday, the $1,750 maximum applies to services through June 30 of that benefit year, then resets on July 1. If you are in MassHealth-approved orthodontic treatment when you turn 21, continued treatment may be covered beyond the maximum.
Ready to Check Your Benefits?
Call 978-288-1000 and tell us you have MassHealth. We will verify your coverage and, for adults 21 and older, check how much of your annual maximum is left.
Other locations: Boston 857-888-8000 | Lowell 978-999-9000 | Waltham 781-666-6000 | Fairhaven 508-967-1000
