Insurance Coverage Details

For Children and Adults (MCA)

Medicaid for children as well as adults under age 65 who are not blind or disabled.

This includes Dr. Dynasaur which is Medicaid for children under age 19 and pregnant people.

Eligibility is based on household income size.

Visit Vermont Health Connect to get details about the program and to apply.

Medicaid for Former Foster Care Youth
You may be able to get Medicaid IF you:

Are a young adult under age 26 AND

Aged out of foster care in Vermont or another state.

Medicaid for Former Foster Care Youth is free. It does not matter how much income you have. Visit Vermont Health Connect to apply.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a covered benefit for children and youth under age 21. The limitations on services and the list of services not covered for adults may not apply to children and youth under age 21. 

To request coverage for members under age 21, a Medicaid enrolled provider should submit a prior authorization request. Prior authorization forms can be found on the Clinical Prior Authorization Forms webpage.

Delta Dental of Vermont coverage varies by plan, but generally includes preventive, basic, and major services with different reimbursement percentages and limitations. Common features include 100% coverage for diagnostic and preventive care, 60–80% for basic restorative work, and 50% for major services, with a plan year deductible and maximum. Many plans use the Northeast Delta Dental network, where participating dentists handle claims and payments are often made directly to the provider. 

General coverage details 

Preventive & Diagnostic: Typically covered at 100% and includes cleanings, exams, and X-rays. There are often limits on how often these services are covered per year.

Basic Restorative: Covers services like fillings and simple extractions, often with a percentage-based reimbursement, such as 60–80% or 70%.

Major Restorative: Includes crowns, bridges, dentures, and implants, with lower reimbursement rates like 50% and often a waiting period.

Orthodontics: Coverage is not standard and may require a special rider or specific plan, with coverage limits and waiting periods that can vary significantly.

Network: Plans often operate within the Northeast Delta Dental PPO and Premier network, which can help reduce out-of-pocket costs.

Deductibles and Maximums: Most plans have an annual deductible (e.g., $50) and a maximum payout per person (e.g., $1,500).

Key considerations 

Read your specific policy: The exact coverage depends on the plan you have. The information above is a general overview, and you should always read your specific policy documents for details on waiting periods, limitations, and exclusions.