Generally, Original Medicare does not cover the cost of dentures. However, some Medicare Advantage Plans may offer partial coverage. Understanding coverage options for dentures and other dental procedures can help Medicare beneficiaries make informed healthcare decisions and potentially minimize costs.
Read on to learn more about what to expect when getting dentures, the average out-of-pocket costs, and coverage alternatives to keep your dentures more affordable.
Table of Contents
Dental Care’s Role in Overall Health for Older Americans
Dental care is critical for maintaining overall wellness, especially for older individuals. Approximately 68% of adults aged 65 or older suffer from gum disease, while 20% have untreated tooth decay. In addition, nearly one in five have lost all of their teeth.
Unfortunately, excessive tooth decay, gum disease, and tooth loss can all lead to the need for full or partial dentures. Some of the most common reasons Medicare beneficiaries need dentures include:
- Wear and tear: Over the years, natural teeth can suffer from significant wear and tear, including enamel erosion and fracture, making dentures a necessary solution for maintaining oral function and health.
- Medication side effects: Certain medications commonly used by older adults can have side effects that negatively impact dental health. For example, dry mouth increases the risk of tooth decay and gum disease.
- Chronic nutrition issues: Poor nutrition can lead to dental health problems, including tooth decay and gum disease.
- Oral cancer: Treatments for oral cancers often necessitate the removal of teeth, either directly because of tumor removal or as a consequence of radiation or chemotherapy.
- Bone loss in jaw: Without teeth, the jawbone can deteriorate over time. Dentures may be required to maintain the structure of the mouth and face.
The Process of Getting Dentures
While each individual’s experience may differ, there are typically several steps involved in getting dentures.
- Initial consultation. A dental professional provides a detailed evaluation to determine the type of denture that’s appropriate for the patient’s needs. During this phase, you receive an estimate of the total cost.
- Preparatory procedures. Some patients may need tooth extractions or treatment for gum disease before being fitted for dentures. Several dental visits may be required to ensure the mouth is healthy enough for a denture fitting.
- Fittings. During the fitting process, the dentist takes precise impressions of the mouth, which are then used to create a custom set of dentures. The initial fitting may be followed by one or more adjustment appointments, ensuring the dentures are functional and fit comfortably.
- Ongoing maintenance. Once dentures are fitted and fully adjusted, regular maintenance is crucial. This includes routine check-ups for wear and fit, along with professional cleanings.
Understanding Medicare and Dentures
Original Medicare offers limited coverage for dental care. It generally does not cover dental services unless they are medically necessary and directly connected to a health condition covered by Medicare. For this reason, Original Medicare never covers dentures.
However, those needing coverage may find that a Medicare Advantage Plan helps offset the costs. Medicare Advantage Plans, also called Medicare Part C, are offered by Medicare-approved private insurance companies. These plans must have at least the same benefits as Original Medicare, but many also include additional benefits such as Medicare Part D prescription drug coverage and vision, hearing, and dental care.
If the plan provides dental benefits, it may cover the cost of dentures. Some Medicare Advantage Plans also offer wellness benefits and allowances for certain over-the-counter products, providing comprehensive healthcare coverage.
Additional Benefits Related to Dentures
Medicare Advantage Plans with comprehensive dental benefits may have additional benefits that can make getting dentures more affordable. Additional benefits vary from plan to plan but commonly include:
- Part D drug coverage: Many Medicare Advantage Plans include Part D, which helps beneficiaries pay for their prescription drugs. Part D may help cover the medications beneficiaries need to treat or alleviate symptoms of the conditions that caused their tooth loss.
- Routine dental care: Medicare Advantage Plans often include dental benefits, which could cover the follow-up appointments needed for preparation for dentures and all the follow-up fittings.
- Over-the-counter (OTC) items: Some plans have allowances for health-related items you can buy without a prescription. OTC coverage could help cover things like non-prescription pain medication if you are having trouble adjusting to your dentures.
- Non-emergency medical transportation: Transportation benefits can help you get rides to and from your medical appointments and pharmacies. This can be useful for those who need help getting to the doctor for follow-up and denture maintenance appointments.
To find a Medicare Advantage Plan that offers additional benefits related to dentures, work with a licensed insurance agent or broker.
How Much Dentures Cost with Medicare
Since dentures are not covered by Original Medicare, beneficiaries without other types of coverage are responsible for 100% of the cost. Generally, you can expect to pay between $500 and $3,500, depending on a range of factors, including the type of dentures, your location, and the other required dental services.
The cost of dentures for seniors with Medicare Advantage Plans also varies depending on the plan’s benefits and cost structures. Out-of-pocket costs include:
- Premium: All Medicare beneficiaries pay for their Medicare Part B premium. Some Medicare Part C plans have another premium in addition to the Part B premium, but some are premium-free.
- Deductible: The deductible is the amount you pay for covered health care services before your insurance plan starts to pay. With a Medicare Advantage Plan, you might have a separate deductible for dental services, including dentures.
- Copayments: Copays are a fixed dollar amount you pay for a covered health care service after you’ve paid your deductible, such as $20 per visit. If your plan covers dentures, you might pay a copayment for each visit to the dentist or dental specialist.
- Coinsurance: The coinsurance is your share of the costs of a covered health care service, calculated as a percent of the allowed amount. For example, you may be responsible for 20% of the approved cost.
- Annual out-of-pocket maximum: Medicare Advantage Plans have an annual out-of-pocket maximum that limits the amount you pay each year for covered services. Once you reach this limit, your plan pays 100% of the costs of covered expenses for the rest of the year. In 2024, the limit is $8,850, though some Medicare Advantage Plans may set lower limits. Original Medicare does not have a limit.
Other Options for Denture Coverage
People seeking coverage for dentures and other dental procedures may consider exploring alternatives beyond Medicare Advantage. Evaluating the coverage, eligibility, and cost of each of the following can help you choose the appropriate option for your needs:
- Stand-alone dental insurance: Private insurance plans specifically designed to cover dental services may provide coverage for dentures. They typically require out-of-pocket premium payments and may have deductibles, copayments, and coinsurance.
- Medicaid: Medicaid may offer dental benefits, including dentures, for eligible low-income individuals and families. Coverage varies by state, so check with your state’s Medicaid program for more details.
- Community health programs: Many communities have health centers or programs offering dental services at reduced costs. These can sometimes include denture services, particularly for seniors or those with limited income. Local health departments or social services can provide information regarding available programs.
Putting It All Together
Proper dental care is crucial for seniors, and many health conditions can lead to the need for dentures. Since Original Medicare does not cover dentures, beneficiaries may consider seeking alternative coverage to offset a portion of the costs.
Medicare Advantage Plans and stand-alone dental plans may cover dentures, as well as the appointments needed before and after to prepare and maintain your dentures. If you expect to need dentures in the future, work with a licensed agent to review your options.