Apple Health is Washington State’s version of Medicaid. It’s a free or low-cost insurance plan that helps cover medical and dental care for people who qualify. You may be eligible if you meet certain income limits or have specific needs. People who usually qualify include:
- Kids and teens under 21 from low-income households
- Adults ages 19–64 with low income (even if you don’t have kids)
- Parents or caregivers of minor children
- Pregnant individuals (coverage includes prenatal and postpartum care)
- Seniors (65+), people with disabilities, or those who are blind, if their income and resources are limited
Once you’re approved, you’ll get a ProviderOne card—your Apple Health ID. Bring it to your dental appointments, and in most cases, you won’t pay anything for covered treatments.
At btyDENTAL, we’re proud to accept Apple Health (Medicaid) at our Sumner and Tacoma office. Bonney Lake (BL) and DuPont (DP) will begin accepting Apple Health in the coming months, so stay tuned!
Dental Coverage for Kids on Apple Health
If your child is covered by Apple Health, good news—they get full dental benefits. That means nearly everything your dentist says is needed for their health is included at no cost to you. Apple Health covers a wide range of care for patients under 21, including:
- Routine checkups and cleanings (usually every 6 months)
- Dental X-rays
- Fluoride treatments and sealants
- Fillings and crowns
- Tooth extractions
- Braces (with approval)
Even better? Kids can start seeing the dentist as early as age 1—and Apple Health pays for those early visits too. Starting young helps prevent bigger problems later on.
What About Braces?
Braces can be covered, but they need prior approval. Your orthodontist will submit a request to Apple Health to show that treatment is medically necessary, not cosmetic. If approved, Apple Health will cover the cost during the full course of treatment.
Dental Coverage for Adults on Apple Health
A lot of people don’t realize this, but Apple Health also covers dental care for adults—not just kids. If you’re 21 or older and enrolled, you can still get many essential dental services without paying out of pocket. Here’s what Apple Health will typically cover:
- Routine dental exams and cleanings
- Dental X-rays
- Fillings (for cavities)
- Fluoride treatments
- Gum disease treatment (periodontal care)
- Root canals on front teeth
- Tooth extractions and oral surgery
- Dentures and partials
- Sedation or anesthesia (when needed for a procedure)
What Dental Treatments Aren’t Covered by Apple Health
Some treatments aren’t included for adults because they’re considered elective or too expensive. These include:
- Braces or orthodontics
- Dental implants
- Bridges
- Porcelain crowns (tooth-colored)
- Root canals on back teeth (molars/premolars)
- Cosmetic treatments like teeth whitening or veneers
In most cases, if a tooth can’t be saved using the covered treatments, extraction and dentures are the fallback solution.
What to Know About Apple Health Rules and Limits
Like any insurance, Apple Health comes with a few rules. Knowing them upfront can save you time, confusion, and surprise bills.
How Often You Can Get Care
Apple Health limits how many times you can get certain services each year. It’s all about making sure care is needed—not overused.
- Routine exams and cleanings are typically covered every 6 months
- X-rays may be limited to once a year (or once every few years for full-mouth scans)
- Fillings and other procedures may also have yearly quantity limits
Your dental provider will help you track these limits and may adjust your treatment schedule to stay within what’s covered.
Some Procedures Need Approval First
For some treatments, your dentist has to get permission from Apple Health before proceeding. This is called prior authorization—and it’s a way to confirm the care is medically necessary.
- Braces for children must be approved in advance
- Special surgeries (like complex oral surgery or periodontal surgery) may require review
- Replacing dentures early may also need approval if they’re lost or broken
Your dental office will handle the paperwork, but it can take days or weeks to get a decision—so it’s good to plan ahead.
Medical vs. Cosmetic: What’s the Difference?
Apple Health only covers care that’s medically necessary—not procedures done just for looks or convenience.
- Covered treatments include care that relieves pain, treats infection, or helps you chew and speak normally
- Not covered: teeth whitening, veneers, implants, or braces for adults (unless there’s a serious medical reason)
- If a treatment isn’t covered, your dentist should let you know before moving forward
Always ask if you’re unsure—our team at btyDENTAL are more than happy to walk you through what’s covered, what’s optional, and alternatives you can go with.
Special Exceptions for Certain Patients
Some patients may qualify for extra services based on their health needs. Apple Health offers added coverage in certain cases.
- People with diabetes can get up to 4 gum cleanings per year to manage oral health
- Adults with developmental disabilities may receive more frequent exams, cleanings, and periodontal services
- Patients who need dental care in special settings (like under anesthesia or in mobile clinics) are often covered too
If you fall into any of these categories, let your dental office know—you might be eligible for more than the standard coverage.
Best Way to Use Your Apple Health Dental Benefits
Now that you know what’s covered, here are some tips to make the most of your Apple Health (Medicaid) dental coverage—from booking your first visit to getting the care you need.
Find a Dentist Who Accepts Apple Health
Start by finding a provider that works with Apple Health. Not every dentist does, so it’s always good to ask first.
- You can use DentistLink, a free referral service in Washington (call or search online)
- Or try Insure Kids Now, especially for children’s dentists
- You can also just call local dental clinics and ask, “Do you accept Apple Health (Medicaid)?”
btyDENTAL Sumner and Tacoma accepts Apple Health patients of all ages. If you’re looking for a place to start, we’re here to help. So don’t hesitate to give us a call!
Mention Apple Health When Booking
When scheduling your appointment, let the office know you have Apple Health. This helps them:
- Confirm your coverage
- Book you into the right type of visit
- Give you a heads-up if there are any limits or wait times for Medicaid slots
Some clinics have designated spots for Medicaid patients, so being upfront helps everything go more smoothly.
Bring Your ProviderOne Card and ID
When you come in for your appointment, bring these two things:
- Your ProviderOne card (your Apple Health ID)
- A valid photo ID (for adults); for kids, a parent’s ID plus the child’s card is usually enough
No need to bring cash—you won’t be charged for covered services. This is one of the biggest benefits of Apple Health: there are no co-pays, no deductibles, and no surprise bills—as long as the procedure is covered.
If you ever receive a bill for something that should’ve been included, contact the clinic or Apple Health. Billing mistakes can happen, but patients should not be charged for covered care.
Plan for Treatment Appointments
If you need more than a checkup—like a filling, denture, or deep cleaning—your dentist will explain the next steps. Sometimes:
- Treatment can be done same-day
- Other times, you’ll need to come back for another visit
- If a procedure needs prior approval, the office will submit it and call you when it’s ready
Be sure to show up for scheduled appointments or give notice if you need to reschedule. Missed appointments can delay your care and impact future scheduling.
Key Takeaways
Apple Health makes it easier to get the dental care you need—without worrying about cost. From preventive visits to essential treatments, there’s a lot it covers. And knowing how to use your benefits means fewer surprises and better long-term health.
At btyDENTAL, we proudly accept Apple Health at many of our locations across Washington. Whether it’s your child’s first checkup or your own smile that needs some attention, we’re here to guide you every step of the way.
Because at btyDENTAL, we believe your smile should always be better than yesterday.
Ready to Schedule Your Next Dental Appointment?
If you’re near Sumner or Tacoma, btyDENTAL can help you with all your concerns about Apple Health/Medicaid.
