Many seniors find themselves needing dentures as they get older. Dentures can be pretty expensive, and most seniors and retirees are enrolled in Medicare health care 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 to know about getting dentures while on Medicare, including coverage details and how much it should cost you.
Â
Does Medicare Cover Dentures?
Unfortunately, Original Medicare does not cover dentures. In fact, Original Medicare does not provide any dental coverage at all. Medicare Part A provides your hospital insurance. This covers hospital stays and inpatient care, like hospice care or some home health care. Medicare Part B is your medical insurance that covers doctor’s office visits, outpatient services, durable medical equipment, and a few other items. If you need dental insurance, then you will need to purchase a supplemental dental insurance plan or a Medicare Advantage plan that provides dental benefits.
There are a couple of limited exceptions where dental services are covered by Medicare. The most common situation is when certain 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 as a result of a non-covered dental procedure like oral surgery, your Part A benefits will cover the hospital stay. Oral exams necessary for things like a kidney transplant or a heart valve replacement will also be covered.
Â
Dental Coverage With Medicare Advantage Plans
Medicare Advantage plans, or Medicare Part C, often provide people with many additional benefits beyond those provided by Original Medicare. Remember that these plans are managed by private insurance companies, so they get to set their own rules when it comes to coverage details and rates. They must, however, provide at least the same minimum level of coverage as Original Medicare. Most Advantage plans provide additional benefits like dental coverage, vision coverage, prescription drug coverage, gym memberships, and other benefits.
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 that are due when services are performed. Enrollment in a Medicare Advantage plan is not difficult. Simply 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!
Â
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. Simply find a standalone dental plan that offers the benefits you need. You can sign up for that plan in addition to your Original Medicare coverage. 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.
Unfortunately, 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 dental services are not covered by Medicare, your Medigap plan will not cover these costs.
Some people simply choose to forego dental coverage altogether and pay for dental services out of their own pocket. This can be a good option for those individuals who rarely need dental work other than routine dental care. They find that paying for routine cleanings ends up being 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 on your own is cheaper in the long run, especially if you do not visit the dentist often.
Â
Cost Of Dentures With Medicare
Most Medicare beneficiaries are interested in the cost of dentures when they are enrolled in the Medicare program. So, how much do dentures cost with Medicare? The pricing of dentures ranges anywhere from $600 to $2,500 for a complete set of dentures. Partial dentures can cost anywhere from $300 to $800. If your only health insurance is Original Medicare, you will need to pay 100% of these costs. Remember that Original Medicare provides no dental benefits — not even for preventive services, so 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. First, make sure to visit a provider who accepts your Medicare plan. The amount that 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 your cost for a complete set of dentures to between $200 to $1,000. This provides a significant financial benefit to anyone who needs dentures as the cost is much lower than paying for the full amount out of your pocket.
Â
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 will need to pay for dentures completely out of your pocket. Many Medicare Advantage plans provide dental benefits, and other people choose to enroll in a supplemental dental plan to go along with their Medicare benefits. Having a plan that provides these benefits can greatly reduce your out-of-pocket expenses related to dentures. If you need assistance finding the right dental plan, you should seek the help of a licensed insurance agent in your area.
Â
Frequently Asked Questions
Â
How often will Medicare pay for a set of dentures?
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. On average, most plans will pay for dentures every five years. 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.
Â
Is there a limit to the amount of times Medicare will cover dentures?
There is generally no limit to the number of times that a dental plan will cover 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 quite high, and most people never hit that mark.
Â
Does Medicare pay for dentures in the hospital?
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.
Â
Does Medicare cover partial dentures?
Original Medicare does not cover partial dentures or full dentures. So, does Medicare cover dental at all? No, Original Medicare provides no dental benefits at all, except in a few emergency situations. If you have a Medicare Advantage plan or supplemental dental coverage that provides benefits for dentures, those plans usually cover both partial and full dentures. They can cover as much as 50% to 60% of the cost of dentures for you. These plans can be a great benefit to individuals who frequently need dental care.
