As we age, tooth decay and tooth loss are more common than you may think. In 2015, 178 million Americans had lost at least one tooth, and more than 35 million had lost all of their teeth.
Tooth loss can lead to other health complications, such as poor diet, pain, and lowered self-esteem. One solution is dentures, which can help improve your health in many ways, including improving your ability to chew your food, providing support to your jaw, maintaining the structural integrity of your face, and giving you back your smile.
Original Medicare doesnâ€™t cover dental services, which includes dental equipment like dentures; however, other healthcare options, like Medicare Advantage and standalone dental insurance policies may help cover or lower your out-of-pocket costs for dentures.
When does Medicare cover dentures?
If you have a health condition that requires surgical removal of your teeth, Medicare may provide some coverage for the tooth extraction. But original Medicare (Part A and Part B) does not cover dentures of any type, for any reason.
If you have a Medicare Advantage plan, your specific plan may offer some provision for dental coverage, including dentures. If you have Medicare Advantage, you can call your insurance provider to confirm that you have coverage for dentures. Ask if there are certain criteria you need to meet to qualify for this coverage.
Medicare doesnâ€™t typically cover any dental services. There are only a few notable exceptions:
- oral exams done in the hospital prior to kidney replacement and heart valve surgery
- tooth extraction and dental services if they are deemed necessary to treat another, non-dental condition
- dental services needed as a result of cancer treatment
- jaw surgery and repair as a result of a traumatic accident
Which Medicare plans may be best if you need dentures?
If you know that youâ€™ll need dentures this year, you may want to take a look at your current health coverage to see if you could benefit from switching to a Medicare Advantage policy. Standalone dental insurance policies may also help reduce the costs of dentures.
Medicare Part A
Medicare Part A provides inpatient hospital coverage. If you have a health condition that requires an emergency inpatient tooth extraction in the hospital, it may be covered under Medicare Part A. Prosthetic dentures or dental implants needed as a result of that surgery are not included in that coverage.
Medicare Part B
Medicare Part B is coverage for outpatient medical care such as doctorâ€™s appointments and preventative care,. However, Medicare Part B does not cover dental services, such as dental checkups, cleanings, X-rays, or dental equipment like dentures.
Medicare Part C (Medicare Advantage)
Medicare Advantage (Part C) is a type of Medicare coverage plan provided through private insurance companies. These plans are required to cover everything original Medicare does, and they often cover more. Depending on your plan, dental services may be covered and may pay some or all of the costs of your dentures.
Medicare Part D
Medicare Part D covers prescription medication. Medicare Part D requires a separate monthly premium and isnâ€™t included in original Medicare. Part D doesnâ€™t offer dental coverage, though it may cover pain medications you are prescribed after an inpatient oral surgery.
Medigap plans, also called Medicare supplement plans, can help you bring the costs of Medicare coinsurance, copays, and deductibles down. Medigap plans can make having Medicare cheaper, even though you have to pay a monthly premium for the supplement plans.
Medigap doesnâ€™t expand the scope of your Medicare coverage. If you have original Medicare, a Medigap policy wonâ€™t change what you pay out of pocket for dentures.
What are the out-of-pocket costs for dentures if you have Medicare?
If you have original Medicare, it will not cover any of the cost for dentures. You will need to pay the entire cost of dentures out of pocket.
If you have a Medicare Advantage plan that includes dental coverage, that plan may pay for a portion of the costs of dentures. If you know you need dentures, review Medicare Advantage plans that include dental to see if that dental coverage includes dentures. You can contact the insurance provider for any Medicare Advantage plan to confirm what is covered by a specific plan.
Dentures can cost anywhere from $600 to over $8,000 depending on the quality of dentures you choose.
You will also need to pay for the denture-fitting appointment as well as any follow-ups, diagnostic tests, or additional appointments that you have with your dentist. Unless you have standalone dental insurance in addition to Medicare or have a Medicare Advantage plan that includes dental coverage, all of this is out-of-pocket, too.
If you are a member of a union, a professional organization, a veteran organization, or an organization for senior citizens, you may be eligible for discounts with your dentist. Contact your dentist to ask about any membership or club discount programs in which they might participate.
If you average the cost of your dental care and divide it by 12, you have a rough estimate of what your dental care is costing you each month. If you can find dental coverage that costs less than that amount, you may save money on dentures as well as dental appointments throughout the year.
Original Medicare wonâ€™t cover the cost of dentures. If you know you need new dentures in the coming year, your best option may be switching to a Medicare Advantage plan that offers dental coverage during the next Medicare enrollment period.
Another option to consider is purchasing private dental insurance.
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