Yes. Health First Colorado, the state’s Medicaid program, provides dental coverage for adults aged 21 and older at no cost to the member. There are no co-pays, no deductibles, and since July 2023, no annual dollar cap on how much dental care you can receive.1Health First Colorado. Health First Colorado Adult Dental Benefit Summary2Department of Health Care Policy and Financing. Health First Colorado Dental Benefits Every covered service is paid at 100 percent of the covered amount.
What’s Covered
The adult dental benefit reaches well beyond basic cleanings. Covered services include:2Department of Health Care Policy and Financing. Health First Colorado Dental Benefits
- Routine cleanings and oral exams, silver diamine fluoride treatments, and full-mouth or panoramic X-rays
- Silver and tooth-colored composite fillings
- Root canals (wisdom teeth excluded; second molars require clinical criteria)
- Crowns (same wisdom-tooth exclusion and second-molar criteria)
- Simple and surgical extractions
- Complete and partial removable dentures, plus repairs, rebasing, and relining
- Periodontal care, including scaling and root planing, maintenance cleanings, full-mouth debridement, and periodontal surgery when clinical criteria are met
- General anesthesia and IV-conscious sedation when performed with other covered procedures
What’s Not Covered
A few common procedures sit outside the benefit entirely. Dental implants and bridges (fixed partial dentures) are not covered at all. Orthodontia for adults is excluded, as are purely cosmetic treatments like teeth whitening.1Health First Colorado. Health First Colorado Adult Dental Benefit Summary Root canals and crowns on wisdom teeth are also excluded, which means a problem wisdom tooth is typically pulled rather than saved.
Frequency Limits You Should Know About
The dollar cap is gone, but most services carry built-in frequency limits. Hit one, and you’ll either wait or pay out of pocket.4Health First Colorado. Health First Colorado Adult Dental Benefit Summary
One more limit catches people off guard: replacing a denture that was lost, stolen, or broken beyond repair is a one-time lifetime benefit.3Department of Health Care Policy and Financing. Health First Colorado Dental Benefits A second replacement will not be covered.
Services That Need Prior Authorization
Some procedures must be approved before the appointment. Your dentist submits the request, but it’s worth knowing which services trigger the extra step so a scheduling delay doesn’t surprise you:1Health First Colorado. Health First Colorado Adult Dental Benefit Summary
- Crowns
- Partial dentures
- Complete dentures
- Periodontal scaling
Other less common procedures may also require authorization. Ask the office before scheduling. A service performed without a required authorization can be denied after the fact, which can leave you on the hook for the cost.
Who Qualifies
You need to be enrolled in Health First Colorado and 21 or older for the adult dental benefit.2Department of Health Care Policy and Financing. Health First Colorado Dental Benefits Enrollment itself depends on household income and family size. For adults ages 19 to 65, the approximate monthly income limits are:5Health First Colorado. Do You Qualify
- 1 person: up to $1,735 per month
- 2 people: up to $2,345 per month
- 3 people: up to $2,954 per month
- 4 people: up to $3,564 per month
Pregnant members, people 65 and older, and people with disabilities fall under different thresholds and should check directly with Health First Colorado.
If you’re 19 or 20, you’re enrolled under a different dental benefit. Members age 20 and under receive dental care through the Early and Periodic Screening, Diagnostic and Treatment program, which actually requires the state to cover all medically necessary dental services and is broader than the adult benefit.6Department of Health Care Policy and Financing. Early and Periodic Screening, Diagnostic and Treatment You still have dental coverage; it just comes through a different door.
How to Apply
You can apply in any of the following ways:7Health First Colorado. Apply Now
- Online through PEAK at co.gov/peak — the fastest route, with most applicants getting a decision right away
- By phone at 1-800-221-3943 (State Relay: 711), Monday through Friday, 8 a.m. to 4 p.m.
- By mail, using a paper application from hcpf.colorado.gov
- In person at your county’s human services office or a local application assistance site
Finding a Dentist
Health First Colorado contracts with DentaQuest to run the dental benefit. New members receive an ID card and welcome packet from DentaQuest after enrolling.2Department of Health Care Policy and Financing. Health First Colorado Dental Benefits To find a participating dentist, search by location at DentaQuest.com or through the DentaQuest Member Portal. You can also call DentaQuest member services at 1-855-225-1729 (State Relay: 711), Monday through Friday, 7:30 a.m. to 5 p.m. Mountain Time.1Health First Colorado. Health First Colorado Adult Dental Benefit Summary
Confirm with the office directly before scheduling. Networks change, and an out-of-network visit won’t be covered.
If a Service Is Denied
You have the right to appeal a denial from Health First Colorado or DentaQuest. The denial letter explains how, and the deadlines matter. If a service you were already receiving is being reduced or stopped and you want it to continue during the appeal, the Office of Administrative Courts must receive your request within 10 days of the date on the notice. If the first-level appeal through DentaQuest doesn’t go your way, you can request a state fair hearing within 60 days of the denial notice. An expedited appeal is available when waiting would put your health at risk.8Health First Colorado. Appeals