Many seniors need dentures as they age. Dentures can be expensive, and most seniors and retirees are enrolled in Medicare healthcare coverage. They often wonder whether Medicare will cover the cost of their dentures.
In addition to dentures, they also need routine dental services, like cleanings, fillings, and other dental care.
If you wonder whether Medicare provides dental coverage for dentures and other items, keep reading. We will tell you everything you need about getting dentures while on Medicare, including coverage details and how much it should cost.
Does Medicare Cover Dentures?
Unfortunately, Original Medicare does not cover dentures. Original Medicare does not provide any dental coverage at all.
- Medicare Part A provides hospital insurance. It covers hospital stays and inpatient care, such as hospice care or some home health care.
- Medicare Part B is your medical insurance covering doctor’s office visits, outpatient services, durable medical equipment, and other items.
If you need dental insurance, you must purchase a supplemental dental insurance plan or a Medicare Advantage plan that provides dental benefits.
- There are a couple of limited exceptions where Medicare covers dental services. The most common situation is when specific dental care is medically necessary to treat another condition.
For example, if you need emergency jaw reconstruction surgery after an accident and a tooth extraction is required to perform the surgery, your Medicare benefits will pay for the extraction.
Similarly, if a hospital stay is required for a non-covered dental procedure like oral surgery, your Part A benefits will cover the stay.
Oral exams necessary for kidney transplants or heart valve replacements will also be covered.
KEY TAKEAWAYS
- Original Medicare does not cover the cost of dentures or other dental services, except if a specific dental procedure is necessary to treat other medical conditions.
- Enrollment in specific Medicare Part C (Medicare Advantage) plans can include dental coverage, including dentures. However, they generally have low annual maximum coverage.
- A standalone dental insurance plan may be the best option for individuals needing denture coverage.
Dental Coverage With Medicare Advantage Plans
Medicare Advantage plans, or Medicare Part C, often provide people with many additional benefits beyond those of Original Medicare.
- Remember that these plans are managed by private insurance companies, so they get to set their own rules regarding coverage details and rates.
- They must provide at least the same minimum level of coverage as Original Medicare. Most Advantage plans offer additional benefits like dental, vision, prescription drugs, gym memberships, and more.
If you are enrolled in one of these Medicare plans, you should check your plan details for dental coverage information. Most follow a cost-sharing model that includes deductibles, copays, and coinsurance amounts due when services are performed.
Enrollment in a Medicare Advantage plan is not difficult. Find and compare plans that are available in your area through Medicare.gov. Once you have selected the plan that works for you, contact the insurance company that manages the plan to get signed up.
While many Medicare Advantage plans include a dental plan, many of those plans have annual maximums. This means that your plan will pay no more than the maximum amount each year.
It is common to have an annual maximum of $1,000 or $1,500. Dentures can be more expensive than this, so you might still find yourself with a high out-of-pocket cost to pay for dentures. However, having any dental coverage at all can be a huge help!
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Other Coverage Options For Dental Services
If you decide not to enroll in a Medicare Advantage plan, is there any other way to get dental coverage while on Medicare? Yes, there is!
Many people choose to add a supplemental dental plan to their Medicare coverage. This works much the same way as adding a Part D prescription drug plan to your coverage.
Standalone Dental Plan
Find a standalone dental plan that offers the benefits you need. In addition to Original Medicare, you can sign up for a standalone dental plan. These plans often pay for cleanings, x-rays, fillings, root canals, dental implants, and other dental work. Most of them will also greatly help with the cost of dentures.
Medigap (Not an Option)
Medicare supplement insurance will not help pay for dental care. A Medicare supplement plan or Medigap plan covers out-of-pocket costs that are not paid for by your Original Medicare coverage. However, since Medicare does not cover dental services, your Medigap plan will not cover these costs.
Out of Pocket
Some people choose to forego dental coverage altogether and pay for dental services out of their own pocket. This can be a good option for individuals who rarely need dental work other than routine care. They find that paying for routine cleanings is cheaper than paying the monthly premium associated with a dental insurance policy.
When making your decision on which dental coverage option is right for you, make sure that you examine the total cost of any Medicare dental coverage you are considering. Remember that your monthly premiums are not the only cost associated with each plan.
There are also cost-sharing expenses, like deductibles, copays, and coinsurance amounts. You might find that paying for dental expenses out-of-pocket is cheaper in the long run, especially if you do not visit the dentist often.
TIP
Calculate the out-of-pocket costs, including premiums, copays, deductibles, etc., to determine if standalone dental insurance is cheaper than cash payments.
Cost Of Dentures With Medicare
Most Medicare beneficiaries are interested in the cost of dentures when enrolled in the program. So, how much do dentures cost with Medicare?
A complete set of dentures costs between $600 and $5,000, and partial dentures can cost between $300 and $2,500.
- If your only health insurance is Original Medicare, you must pay 100% of these costs. Remember that Original Medicare provides no dental benefits — not even for preventive services so that you will be responsible for the total cost of your dentures.
If you have a Medicare Advantage plan or other Medicare dental plan that provides benefits for dentures, your cost will be much lower. Make sure to visit a provider who accepts your Medicare plan. The amount you will need to pay varies by plan, but it is usually around 40% of the cost of the service. This means that your plan will cover approximately 60% of the cost of the dentures.
This could lower the cost of a complete set of dentures to between $240 and $2,000. This provides a significant financial benefit to anyone needing dentures, as the price is much lower than paying the total cost.
The Bottom Line
Original Medicare does not cover dentures, and it does not cover any routine dental services. If you are only enrolled in Original Medicare, you must pay for dentures entirely out of pocket.
Many Medicare Advantage plans provide dental benefits, and others choose to enroll in a supplemental dental plan to accompany their Medicare benefits.
A plan that provides these benefits can significantly reduce out-of-pocket dental expenses. If you need assistance finding the right dental plan, you should seek the help of a licensed insurance agent in your area.
Frequently Asked Questions
Original Medicare will never pay for a set of dentures. If you are enrolled in a Medicare Advantage plan or supplemental dental coverage, the coverage details vary by plan.
Most plans pay for dentures every five years on average. Purchasing a new set of dentures before you are eligible means that your plan will not cover the expense, and you will need to pay for the cost completely on your own.
There is generally no limit to the number of times a dental plan covers dentures. However, most plans will only cover dentures about once every five years.
Most plans also have an annual maximum and a lifetime maximum. Once you hit the lifetime maximum for benefits, your plan will no longer pay for dentures or other services. Lifetime maximums are usually relatively high; most people never hit that mark.
No, Medicare does not pay for dentures in the hospital.
Your Medicare Part A coverage would pay for your hospital stay but not for dentures. In some limited circumstances, Medicare will pay for limited dental services that are medically necessary to treat another health condition.
However, dentures would seldom fall into this category. Unless you have a Medicare Advantage plan or other dental coverage, you will be responsible for paying for the total cost of your dentures.
Original Medicare does not cover partial dentures or complete dentures. So, does Medicare cover dental at all? No, Original Medicare provides no dental benefits except in a few emergencies.
If you have a Medicare Advantage plan or supplemental dental coverage that provides benefits for dentures, those plans usually cover both partial and complete dentures.
They can cover as much as 50% to 60% of the cost of dentures for you. These plans can significantly benefit individuals who frequently need dental care.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
