Does Medicare Cover Dentures?
Learning about denture coverage and Medicare’s alternative options.
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Oral health is often an overlooked aspect of a person's general health. Simple oral care can significantly reduce your chances of suffering from a number of oral conditions, such as tooth decay, gum disease, dental cavities, and tooth loss.
According to The National Center for Biotechnology Information, over 35 million Americans have lost all of their teeth, and 178 million are missing at least one tooth.
This article will help you understand Medicare, their dental coverage, and more specifically, their coverage of dentures.
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What Is Medicare?
Medicare is a United States federal health insurance program for people 65 or older, some younger people with disabilities, as well as people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
The federal Medicare program has two main sections, Original Medicare and Medicare Advantage. Each section comprises various parts that offer different premiums, deductibles, coverage, and costs.
The plan is made up of four parts.
The Different Parts of Medicare
Medicare Part A refers to inpatient treatment and hospital care, including hospital stays, hospital treatments, and general nursing costs.
Medicare Part B relates to outpatient medical coverage and includes preventive treatments, doctors’ consultations, scans, and tests.
Part C/Medicare Advantage Plans are health plans offered by insurance companies that have contracts with Medicare. These policies cover Part A, B, and D expenses, including costs for hospital care, prescription drug coverage, and doctors’ visits.
Stand-Alone Part D Plans (Prescription Drug Plans) cover self-administered prescription drugs, such as medications for high blood pressure, pain tablets, and antidepressants.
Medicare Supplement Insurance is a health plan for people who have Original Medicare that covers out-of-pocket costs such as deductibles, coinsurance, and co-payments.
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What Are Dentures?
Dentures are prosthetic and removable teeth and gums used to replace missing teeth and surrounding tissues.
There are many different types of dentures such as complete and partial dentures, which depend on the number of teeth missing, as well as removable and implant dentures.
No matter what type of dentures you need, they will be custom designed to fit your mouth and match your other existing teeth.
What Types of Dentures Are There?
- Complete or Full Dentures
There are two types of full dentures:
-Conventional Dentures: These are removable dentures that are made after the patient's teeth had been removed and the gum tissue has begun healing.
Conventional dentures are typically ready to be placed in the mouth about 8 to 12 weeks after teeth removal.
-Immediate Dentures: Unlike conventional dentures, immediate dentures are molded and made before teeth removal and they can be placed in the mouth as soon as the teeth have been extracted.
The patient will not have to go through the healing process without teeth.
- Partial Dentures
These are advised when the patient has at least one or more natural teeth remaining in the lower or upper jaw.
Remaining teeth will help anchor the partial dentures, which are replacement teeth attached to a matching gum-colored plastic base.
- Removable Dentures
These dentures have the capability to be removed from the mouth. Removable dentures should be taken out each night and cleaned. They are typically less expensive than implant dentures.
- Implant Dentures
The opposite of removable dentures, implant dentures are surgically fitted in the patient's mouth.
Implant dentures are permanently fixed to the patient's jaw.
Implant dentures are different from dental implants, which are used to replace teeth one at a time.
How Can I Get Medicare to Cover Dentures?
Original Medicare does not cover dental services, including dentures.
Medicare excludes all dental services, with some specified exceptions.
For example, if dentistry or oral surgery is required for a policyholder, then a broader plan of Medicare will provide coverage.
However, Medicare Advantage and/or stand-alone private dental insurance plans can help cover dental appliances like dentures. These policies may not fully cover these expenses, but will lower your out-of-pocket costs.
To get some coverage for these substantial costs, you will need to enroll in Medicare Advantage or get a private dental insurance plan.
Four Categories of Medicare Advantage Plans
Health Maintenance Organization (HMO) plans cover care from in-network providers, with particular exceptions that include emergency services.
Preferred Provider Organization (PPO) plans allow you to see any provider, but in-network providers tend to cost significantly less.
Private Fee-for-Service (PFFS) plans let you see any provider that accepts the terms of the plan. Some plans have networks that include providers who fit into this category.
Special Needs Plans (SNPs) require you to use in-network providers. They typically have specialists with expertise in the condition(s) that affect you.
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Dentures Coverage through Medicare Advantage Plans
If you have a pre-existing health condition that requires the surgical removal of your teeth, Original Medicare may help provide coverage for the removal.
However, Original Medicare (Part A and Part B) does not cover any form of dentures.
Medicare Advantage plans are the most common way for people to get dental procedure coverage. Medicare Advantage usually covers:
Cleaning
Exams
X-rays
Crowns
Fillings
Root canals
Bridges
Tooth extractions
Implants
Because Medicare Advantage plans are sold through private insurers, the coverage is determined by their policies.
Medicare Advantage plans may provide denture coverage if your specific plan offers provision for dental coverage. This provision could include all kinds of dentures. If you are unsure, then you should call your insurance provider to find out.
What Dental Services Does Medicare Cover?
Original Medicare (Part A and Part B) does not cover dental services, with only specified situations being exceptions, such as:
Oral exams performed in the hospital prior to kidney replacement and heart valve surgery
Tooth extraction and dental services, only if they are deemed medically necessary to treat another non-dental condition
Dental services needed as a result of cancer treatment
Jaw surgery and repair resulting from a traumatic experience
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How Much Do Dentures Cost?
Without Medicare Advantage or a private insurer to cover your dentures, they do come at a price.
According to Fixodent, a worldwide leader in denture solutions, there are three main factors that contribute to the price of your dentures.
Material
Type
Level of Customization
Dentures are made from different materials. Ones made from acrylic are generally cheaper than the porcelain alternative.
Similarly, the type of denture also affects the cost. Full/complete dentures typically cost more than partial dentures, and pre-made removable dentures are far cheaper than properly-fitted upper or lower jaw dentures.
There are also other cost-affecting factors to consider when buying dentures.
The cost of potential teeth removal
The cost of immediate dentures whilst your permanent dentures are being prepared
The cost of follow-up appointments or procedures while you heal, or for adjustments.
According to Fixodent, the average cost of a traditional full set of dentures is around $1,800.
However, the price may vary from dentist to dentist. Follow the guidelines below to get an idea of how much the different denture types cost.
Guide to Various Denture Prices
Low-Cost Dentures range between $300 - $500 per plate. A complete set of lower and upper dentures can cost between $600 - $1,000.
Making them is generally cheaper and lower-quality materials are used.
A complete set of Mid-Priced Dentures will typically cost between $1,000 - $3,000. A single plate of dentures will cost around $500 - $1,500.
This range of dentures looks more natural than the lower-priced dentures and will last longer, too.
Premium Price Dentures can cost between $2,000 - $4,000 per single denture or $4,000 - $8,000 per complete set.
These follow a similar process to the mid-priced dentures, but they are made using high-quality materials and are fully customized to the patient, making them look extremely authentic.
What Are Stand-Alone Dental Plans?
If you don’t end up choosing a Medicare Advantage Plan, a stand-alone dental plan is a good way to get coverage for your dental needs, specifically dentures.
Stand-alone dental plans are bought directly through private health insurance companies. Most of these providers let you sign up for dental insurance even if you don’t currently have medical insurance through their company.
A stand-alone dental plan will be independent of your other coverage and will be able to supply you with the dental care you need and potentially have cost-saving benefits.
What are some of the stand-alone dental plan benefits?
You can choose the level of coverage you want, with plans ranging from basic coverage to plans that cover more extensive dental treatments
You can select an insurance company that includes your preferred dentist in their network of providers without affecting your current medical plan
Medicare Providers That Can Cover Your Dental Needs
If you need dental coverage for your teeth and oral health, we’ve suggested a few Medicare providers below that can help you protect your teeth, and potentially help cover your dentures.
Each provider offers you different types of coverage and various benefits. Make sure that you enquire about how they can help you.
Three Medicare Providers That Support Your Teeth and Oral Health
- eHealth
According to eHealth, they have helped around 5 million people find the right dental insurance over the past 20 years.
They provide more than 600 plans from over 270 dental insurance carriers, with plans starting as low as $8.95 per month.
Similarly, United Healthcare offers a variety of dental plans for you. They can help you find basic dental coverage for general dental and oral care, or choose coverage for major care, such as implants.
United Healthcare includes a range of options so that you can find the one that’s best suited and most affordable.
Aetna is the third-largest health insurance provider in the United States and has an estimated membership of nearly 24 million people, including its Medicare members.
Aetna has some of the cheapest overall monthly prices, costing an average of $7 per month for 2022.
The company can repay the policyholder for in-network dental coverage and provides an option to expand your dental benefits by increasing your monthly payment.
There’s a lot to consider when choosing the right Medicare coverage. PolicyScout prides itself on our customer ratings and reviews, and our staff handpicks the best insurance provider to help you find the perfect fit.
Head over to our Medicare hub to view and compare our various providers. You can also get a quote from each of them to ensure you’re getting the best possible care.
How to Qualify for Dentistry Discounts
If you are a member of a union, a veteran organization, a professional organization, or an organization for senior citizens, you may be eligible for dentistry discounts.
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Where Can I Learn More about Medicare?
If you are with Original Medicare and dental coverage is something that you think you are going to need, specifically denture coverage, perhaps switching to a Medicare Advantage Plan or a stand-alone dental plan could be an option for you.
If you need help, head over to PolicyScout to find the best coverage for you.
If you are looking for up-to-date and accurate information about Original Medicare, Medicare Advantage Plans, or anything Medicare-related, head to PolicyScout’s Medicare hub to compare your options and find the best plan in your area.
If you are looking for personalized guidance, send your questions to Help@PolicyScout.com or call us at 1-888-912-2132 to get assistance from one of our skilled Medicare consultants.
Source: Pexels