What to Know About Medicare and Dentures
In most cases, Medicare does not include dental coverage. This includes coverage for dentures.
However, Medicare beneficiaries can still get dental insurance from other providers.
The Dual-Eligibles program may also help cover denture costs, but this will be dependent on what state the beneficiary is located in.
Healthy teeth and gums are vital for overall health. Gum disease and tooth damage do happen, however, and these scenarios may result in missing teeth. In these situations, special dental work may be needed. One option to replace missing teeth is to get dentures. But does Medicare cover it?
In most cases, Medicare will not cover dentures. This is because dentures fall under the category of dental services, which are not typically included as part of Medicare plans. However, Medicare beneficiaries can still enroll in a separate dental plan that does provide coverage for dentures. Some Medicare Advantage plans may offer additional benefits as well, including vision coverage, hearing, and dental.
What Are Dentures?
Dentures are dental apparatuses used to replace missing teeth, performing the functions of normal teeth. Most dentures are designed to be worn comfortably. Dentures are also removable, meaning they can be cleaned properly to keep everything hygienic and prevent further issues.
Benefits of Dentures
There are a number of benefits associated with dentures. These include:
Helps make chewing easier
Enhances social life and confidence
Does Medicare Cover Dentures?
Original Medicare doesn’t cover routine dental services such as dental procedures, dental care, or dental supplies. This includes:
Various dental devices
However, there are scenarios where certain dental services will be covered. For example, Medicare pays for dental services so long as they are directly related to a Medicare-covered procedure. For example, tooth extractions needed to prepare for radiation treatment for neoplastic diseases involving the jaw would be covered. However, Medicare will not cover dentures that may be needed after said tooth extractions.
Learn more about Medicare and dental at the Center for Medicare and Medicaid Services (CMS) website.
Do Medicare Advantage Plans Cover Dentures?
A Medicare Advantage (MA) plan, also known as Medicare Part C, is provided by private insurance companies that have been approved by the federal Medicare program. Medicare Advantage plans provide the same level of coverage as Original Medicare, including both Medicare Part A and Medicare Part B. In addition to the standard coverage, Many Medicare Advantage plans may provide dental benefits. However, exactly what dental services are covered will vary from plan to plan. A copayment and coinsurance may also be involved, as well as a higher monthly premium if dental benefits are included.
Medicare beneficiaries should consult their MA plan or insurance company for specific information on their dental coverage.
How Much Do Dentures Cost?
According to Fixodent, there are three main factors that contribute to denture pricing:
Material (acrylic or porcelain)
Type (Partial or full)
In addition, other factors that may drive up costs include:
Possible teeth extractions
Immediate dentures to be worn until the permanent set is ready
Potential follow-up appointments
Do Medicare Supplement Insurance Plans Cover Dentures?
Like Original Medicare, Medicare supplement insurance plans also do not offer dental coverage. This is because a Medicare supplement plan is meant to supplement Medicare coverage, meaning offsetting the costs of services already covered by Medicare, not uncovered services.
How To Pay For Dentures
If a Medicare beneficiary does not have a Medicare Advantage plan or another insurance plan that will cover dental services, they would be responsible for all costs.
Medicaid-Medicare (Dual-Eligibles) Program
Depending on the beneficiary’s location, dental services and dentures may be covered. Since Medicaid programs are state-run, this means these government programs can expand their offerings beyond federal guidelines.
Stand-Alone Dental Insurance
If available in the beneficiary’s state, stand-alone dental plans may help. These plans may also offer oral exams, fillings, and other preventative and routine dental care. Dental insurance plans may also help cover the costs of dentures, dental implants, or oral surgery. Dental benefits offered will vary per plan.
Flexible Spending Account (FSA) or Health Savings Account (HSA)
Dentures are eligible for reimbursement through FSAs and HSAs. Learn more at this resource.
Experience the Oak Street Health difference, and see what it’s like to be treated by a care team who are experts at caring for older adults.