The Tooth Bill

How We Check

Where The Tooth Bill gets its Medicare, Medicaid, insurance, tax and credit rules, how each is dated, why some say not confirmed, and how often we recheck.

The rules on who pays for dental work move more than most people expect. Medicare’s list of dental services tied to covered medical care was written into the regulation from 1 January 2023 and widened in 2024 and again in 2025 (42 CFR 411.15(i)(3), eCFR point-in-time versions, read 11 November 2026). In the ADA Health Policy Institute’s adult Medicaid table published in December 2025, seven states moved up a level in 2025 alone. HSA and FSA limits change every year. A rule from an old article can cost someone a few thousand dollars, or a treatment they could have had covered. This page sets out where our rules and figures come from, how we date them, why some rows say “not confirmed”, how often we recheck them, and where our limits are.

General information about costs, not dental, medical, insurance, tax or financial advice. Your dentist decides what treatment suits you; your plan’s documents and a pre-treatment estimate decide what it pays.

Where rules and figures come from

We go to the body that makes the rule, and link it at the claim:

  • Federal regulations and rules: the eCFR, quoted with its “up to date as of” date, and the final rules in the Federal Register that changed them, such as Medicare’s yearly physician fee schedule rules.
  • Medicare: CMS and medicare.gov for what Medicare says it covers and for the year’s deductibles and premiums. For Medicare Advantage dental benefits, the plan’s own evidence of coverage decides, and pages say so.
  • Medicaid and CHIP: medicaid.gov and the US Code for the federal rules on children’s dental care, and each state Medicaid agency’s own pages, manuals and fee schedules for what a state covers.
  • The ADA Health Policy Institute’s Medicaid report: Dental Care in Medicaid Programs, the data tables published in December 2025 with data as of August 2025, for each state’s level of adult dental benefit and HPI’s own definition of each level. Every row carries that date. We don’t mix HPI’s levels with other groups’ scales.
  • The Marketplace: healthcare.gov, the essential health benefit rules in 45 CFR 156.110 and 156.115, and CMS’s yearly Letter to Issuers for the cap on children’s dental out-of-pocket costs.
  • Taxes and accounts: the IRS, by edition: Publication 502 for what counts as a medical or dental expense, Publication 969 for HSAs and FSAs, and the revenue procedures that set each year’s limits.
  • Credit: the Consumer Financial Protection Bureau’s May 2023 report on medical credit cards and its 2013 action against CareCredit, plus each lender’s own published terms, quoted with the day we read them.
  • Low-cost care and veterans: HRSA and the health center rules in 42 USC 254b and 42 CFR 51c.303, and the VA’s dental rules in 38 CFR 17.161 and 17.169 with va.gov.
  • Discount plans: the Federal Trade Commission and the state statutes we have read, such as Florida’s and Texas’s.
  • Real plan documents: the 2026 federal employees’ dental plan brochures, CMS’s files on Marketplace stand-alone dental plans, and individual dental policies we could read in full, cited by name, year and page as examples of how plans are written. They are never presented as what every plan does.
  • What a procedure is: one or two plain sentences from MedlinePlus, NIDCR, the CDC or the FDA, cited, and nothing more clinical than that.
  • Never a source: dental practice blogs, dental chains’ marketing, lead-generation sites, forums, Reddit, YouTube and “best dental insurance” lists. Not for a rule, a coverage statement or a statistic.

Prices have no official source, so they follow a separate method, set out on how we estimate costs. Every source, with its edition and the date we read it, is listed on sources we use.

How a rule gets on the page

Each rule and figure is sorted by how directly it was read, and that decides how we word it:

  • Read in the official text: the regulation, the statute, the agency’s own page or manual, the IRS publication or the named plan document. We state it plainly, with the citation and the date we read it. Before a page uses it, the whole section is read again, not just the sentence that matched a search, because the exceptions often sit further down: adult versus child Medicaid rules, in-network versus out-of-network, per tooth versus per arch, a lender’s promotional versus standard terms.
  • Read only in part, or only in an archived or unofficial copy. It is not stated as a flat rule. If a page needs it, it says what we read, where, and on what date, and points you to the agency to confirm.
  • Not read. It stays off the page, or the page says “not confirmed” and links the official source.

Why some rows say “not confirmed”

Adult dental in Medicaid, denturist licensing and many dental insurance laws are state by state, and there is no national rule to fall back on. HPI’s table gives every state’s level of adult benefit, but not the details: which services, what yearly limit, what copays. We add a state’s details only once we have read them on the state Medicaid agency’s own site. Some agency sites refuse automated access, publish only scanned documents, or had not been read when a page was written. In those cases the row gives HPI’s level with its date, says the details are “not confirmed”, and links the agency.

“Not confirmed” says nothing about what the rule is. It means we have not read it in a source we would stand behind. Changes reported in the news, such as a state budget proposal to cap or cut adult dental, are not stated as fact until the agency’s own text says they took effect. Where we found no rule on a point, we say “no rule found in the sections we read”, not “there is none”.

How rules are named and dated

A rule is right only for a certain year and certain plans, so we name the edition, not just the number:

  • Regulations with their “as of” date. Medicare’s dental exclusion is quoted from the eCFR with the date the eCFR says it is up to date as of. Its exceptions are listed by the year each took effect: 2023, 2024 and 2025. The CY2026 physician fee schedule final rule (90 FR 49266) added none, and the CY2027 final rule, published 9 November 2026 (91 FR 70992), has no dental section, both read in full text 11 November 2026.
  • Yearly limits with their year and source. 2026 HSA limits of $4,400 self-only and $8,750 family come from Rev. Proc. 2025-19; the 2026 health FSA limit of $3,400 and carryover of $680 from Rev. Proc. 2025-32. The Marketplace stand-alone dental plan cap for children is $450 for one child and $900 for two or more in 2026 (CMS Final 2026 Letter to Issuers) and stays the same in 2027. All read 11 November 2026. We never write “the current limit” without the year.
  • Publications by edition. As of 11 November 2026, Publication 502 is the edition for 2025 returns. The edition for 2026 returns usually comes out early in the following year, and pages say which one they use.
  • Medicaid levels with their data date. Every state row says “HPI, December 2025, data as of August 2025”, in text, tables and graphics.
  • Lender terms with the day we read them. A lender can change its rates at any time, so a rate is always “as published on” a date, and your own agreement decides.
  • A checked date on every page. Each page ends with the date its sources were checked.

How calculators work

Our calculators do arithmetic, not decisions. The out-of-pocket calculator applies your plan’s deductible, coinsurance, annual maximum, waiting period and missing tooth clause to a fee you enter, and shows which rule changed the answer. The implant cost estimator adds up published ranges for each part of the work, each with its source and date. The deferred-interest and loan calculator shows what happens if a promotional balance isn’t paid in time, and what a fixed loan costs. The braces payment calculator applies an orthodontic lifetime maximum and spreads your share over the months you enter.

Each formula is tested against answers worked by hand before the calculator goes live. Every default that is a rate or a rule says where it comes from and when we read it, or that it is our assumption, and you can change it. Results say “estimate” and never say which treatment to choose, whether you qualify for anything, or what a plan will certainly pay. A pre-treatment estimate from your plan, and your own credit agreement, decide.

How pages are checked

After a page is written, a separate fact-check compares each rule, limit, date, percentage, code number and price with its source, and works every sum again. A final review looks for errors, gaps and anything that could mislead a reader about what a plan pays, what a program covers or what a credit offer costs, and for anything that drifts into treatment advice. A page with a serious problem still open does not go out.

How often things are rechecked

  • Medicare’s dental rules: after each year’s physician fee schedule final rule, usually published around 1 November, when we read the rule and the eCFR again. Medicare’s deductibles and premiums: when CMS announces the next year’s amounts.
  • Medicaid rows: every 3 months, and after each state’s legislative session or budget, because adult dental benefits are often changed in state budgets. HPI’s table is rechecked when HPI publishes a new edition.
  • HSA, FSA and Marketplace limits: when the IRS publishes the year’s revenue procedures and CMS publishes its Letter to Issuers.
  • IRS publications: when a new edition of Publication 502 or 969 comes out.
  • Price tables: once a year, when we read each publisher’s figures again and note the change in the consumer price index for dental services since they were published.
  • Plan document examples: when the next plan year’s documents are published, such as the federal employees’ dental brochures each autumn.
  • Lenders’ published terms: read again whenever a page that uses them is updated.
  • Everything else: at least every six months, and sooner when we learn a source has changed.

A page shows an updated date only when its content really changed. Between rechecks a rule can change without our knowing, which is why each one shows the day we read it.

What is an assumption

Where we work something out ourselves, we say so. Arithmetic is shown step by step and labelled as ours. A range built from several publishers’ figures is labelled as our arithmetic. Anything a source does not state, such as how many visits a treatment takes or how often something is replaced in a lifetime cost comparison, is labelled “our assumption”, explained in a sentence, and can be changed in the calculator. We give no industry-wide “typical” coinsurance, annual maximum or waiting period, because we found no primary source for one; we show real plan documents as named examples instead.

How we treat claims seen elsewhere

Claims from sellers are reported as claims, never as fact, and we don’t name a seller when we question one. Some lines you may see, checked as of 11 November 2026:

  • “Medicare never covers dental.” Too strong. Medicare does not exclude dental services inextricably linked to certain covered care, such as before an organ transplant or heart valve replacement, or with head and neck cancer treatment (42 CFR 411.15(i)(3)). Routine cleanings, fillings, extractions, dentures and implants are not covered in most cases (medicare.gov). See does Medicare cover dental.
  • “Medicaid doesn’t cover adult dental.” Wrong in most states. In HPI’s table (December 2025, data as of August 2025), 38 states and DC had what HPI calls an enhanced adult benefit; only Alabama had none. See Medicaid dental for adults.
  • “Obamacare plans must cover adult dental.” No. Children’s dental care is an essential health benefit (45 CFR 156.110); routine adult dental may not be counted as one (45 CFR 156.115(d), as in effect November 2026), and healthcare.gov says health plans don’t have to offer adult dental coverage.
  • “0% financing.” Often deferred interest, not waived interest. The CFPB’s May 2023 report explains that if the balance isn’t paid in full by the end of the promotion, interest can be charged back to the purchase date. See dental financing.
  • “A discount plan is cheap dental insurance.” It is not insurance. Florida requires the disclosure “That the plan is not insurance” (s. 636.212), and the FTC says medical discount plans are not insurance. See dental discount plans.
  • “Implants cost $X.” No single national figure exists. Published figures measure different things, from the implant post alone to a finished tooth, so we show them side by side. See dental implant cost.

Our limits

Some sources can’t be read in full, because they block automated access, load only in some browsers or have not been posted. As of 11 November 2026 we had found no primary table of Medicare Advantage dental maximums, had not read Medicare’s 2027 deductibles, and had not read state dental insurance laws beyond Massachusetts, so none of these is stated on our pages. Where an official page could be read only in an archived copy, the page says so and gives the copy’s date. We read regulations, statutes, agency pages and the plan documents a page depends on, not every court decision or every plan’s contract. No check catches everything, so please tell us if you find a mistake. Fixes are logged on our corrections page, and our editorial policy covers the rest of how pages are made.

Before you rely on a rule here, check it with your plan, your state Medicaid agency, Medicare, the IRS or the lender, in writing where you can, and ask your dental office for a written treatment plan and your plan for a pre-treatment estimate.

Sources on this page checked on 11 November 2026.