Out-of-Pocket Costs

The General Rule

For all covered services at in-network providers: members pay $0. No copays, no deductible, no coinsurance, no annual cap.

Where Members Might Pay Out-of-Pocket

1. Implant-Supported Crowns (If Not Covered)

This is the big question mark. If DentaQuest determines that crowns on existing implant stems are not a covered benefit, the member is responsible for the full cost.

Estimated private-pay costs for implant crowns:

Some providers offer payment plans or sliding-fee scales. See Providers/Dental and Implant Centers of Colorado — they specialize in implants and accept Medicaid for other services.

2. Services at Out-of-Network Providers

Health First Colorado only covers in-network (Medicaid-enrolled, DentaQuest-participating) providers. Seeing a provider who doesn't accept Medicaid means paying 100% of the bill.

3. Non-Covered Services

Opting for a procedure Medicaid doesn't cover (cosmetic work, bridges, orthodontics) means paying the full amount.

4. Services Without Prior Authorization

If a procedure requiring prior auth is performed before approval, the dental office takes on the financial risk. However, if the auth is denied after the fact, there's a chance the provider could bill the patient. Always confirm authorization status before treatment.

Ways to Reduce Out-of-Pocket Costs

Sliding Fee Scale Clinics

Community health centers and some dental offices offer sliding-fee-scale pricing based on income. This can significantly reduce costs for services Medicaid doesn't cover.

Dental Schools

University of Colorado School of Dental Medicine offers reduced-cost care performed by supervised dental students.

Payment Plans

Many private dental offices offer financing through CareCredit, Lending Club, or in-house payment plans. Ask before treatment.

DentaQuest Appeals

If a service is denied by DentaQuest, members have the right to appeal. The dentist can help submit additional documentation to support medical necessity. See Resources/Prior Authorization Guide.

Cost Summary by Procedure

See also: Treatment Plan Overview | Coverage Summary | Action Items