DENTAL & VISION INSURANCE VS WAIVER BENEFITS
- DENTAL SERVICES:
- Participants enrolled on the HCBS-DD waiver who are 21 or older receive dental benefits provided by Health First Colorado (Colorado’s Medicaid Program). Additional dental services may be accessed by the participants waiver funding.
Below is a breakdown of the dental benefits waver participants are eligible for:
| Health First Colorado (Medicaid) provided by DentaQuest
Up to $1,500/ year |
Funded by waiver, billed/ provided by DentaQuest (Preventative & basic services)
Up to $2,000/ service plan year |
Funded by waiver, billed/ provided by DentaQuest Up to $10,000/5-year renewal period |
| Annual dental exams & cleanings | Exams, cleaning and x-rays * | Crowns & bridges * |
| Diagnostic & restorative dental services (x-rays & fillings) | Mouth guards * | Dentures * |
| Extractions (tooth pulling) | Topical fluoride treatment * | Implants when necessary to support a dental bridge or when necessary to increase the stability of crowns, bridges, and dentures. * |
| Root canals * | Fillings & root canals * | |
| Crowns * | Dentures, crowns, bridge repair * | |
| Partial dentures * | Non-emergency extractions * | |
| Complete dentures * | Treatment of injuries * | |
| Restoration or recovery of decaying or fractured teeth * | ||
| Dental insurance premiums and co-pays/co-insurance * |
*These services require prior authorization*.
Health First Colorado has partnered with DentaQuest to help members find a dentist and use their dental benefits. If you need help findings a dentist, you can call DentaQuest at 1-855-225-1729 or visit https://dentaquest.com/
- VISION SERVICES:
- Participants enrolled on the HCBS-DD waiver who are 21 or older receive vision benefits provided by Health First Colorado (Colorado’s Medicaid Program).
- Vision services must be provided by a licensed Optometrist or Physician
Below is a breakdown of the vision benefits waver participants are eligible for:
| Health First Colorado (Medicaid)
|
Funded by waiver (Service Plan) |
| Eye exam | Eye exams and diagnosis |
| Glasses & contact lenses ONLY after surgery | Glasses & contact lenses, except after surgery * |
| Other medically necessary methods used to improve specific dysfunctions of the vision system. ** | |
| Lasik and other similar types of procedures |
*Prior to placing an order for glasses or contact lenses, the vendor must submit an invoice to the CMA (Case Management Agency) who will send payment to the vendor so the prescription can be filled.
** Lasik and similar procedures must be medically appropriate and pre-approved by the CMA. Lasik and other similar types of procedures are only prior approved and allowable when the procedure is necessary due to documented specific behavioral complexities (i.e., constant destruction of eyeglasses) that make other more traditional remedies impractical.
Heath First Colorado (Medicaid) members can find an Optometrist through the Health First Colorado website https://www.healthfirstcolorado.com/find-doctors/
