It is very common to lose teeth with aging which leaves the option of relacing those missing teeth with dentures. In fact, about 19% of the population wears some form of dentures. For Medicare beneficiaries it is important to understand the coverage provided. Original Medicare does not typically pay for dentures, but certain Medicare Advantage plans may cover some of these costs related to dentures.
Does Medicare Cover Dentures?
According to the Centers for Medicare and Medicaid Services, Original Medicare usually does not cover dental care, including dentures. The exclusion of dental care has remained the same since 1980.
Medicare also does not typically pay for procedures leading up to getting dentures. But there are a few exceptions. For example:
- If you have a medical condition that requires tooth extraction, Medicare will usually cover the costs.
- The only time Original Medicare pays for dental procedures is if it is a part of a covered medical procedure, such as the reconstruction of the jaw after an accident or oral cancer. For instance, if someone needs a tooth extracted to allow for reconstructive surgery of the jaw following an accident, Medicare Part A covers the costs.
- For routine care and tooth replacement, dentures are not covered.
- Medicare Supplement Insurance Plans (Medigap) does not cover the costs of dentures but may fill the gaps and cover some of the out-pocket-costs that Medicare does not pay.
Do Medicare Advantage Plans Cover Dentures?
Medicare Advantage plans may vary in their coverage of dental services. Although they must offer at least the same coverage as Original Medicare, Advantage plans may offer additional options. Certain Advantage plans help pay for dental services, and that may include dentures.
But plans may differ. Some plans may partly cover dentures or procedures leading up to getting dentures, such as extractions. When it comes to Advantage plans, there are many options. It is helpful to ask a licensed insurance agent about coverage before starting the process of getting dentures. There might be certain criteria you need to meet to qualify for the coverage of dentures.
Options to Pay for Dentures
If you do not have a Medicare Advantage plan and do not have any coverage for dentures, there are options to help cover some of the costs. Consider some of the tips below:
- Shop around: Prices for dental services, such as dentures, can vary greatly. Even in the same community, costs may vary by several hundred dollars. Call several dental practices and ask for a quote.
- Try a community health clinic: Some communities have senior health centers or local community clinics that may help connect you with dental services for those with income restrictions.
- Consider private dental insurance. If you think you need extensive dental work or will need dentures, private dental insurance may be an option. The costs of dental insurance vary. But it may save you money in the long run.
- Join a dental savings plan: Noninsurance dental plans cost a small monthly fee to join. They may negotiate discounts on dental services, such as dentures.
- Facts and Tips; Dentures, Oral Health Foundation.
- Medicare Dental Coverage, CMS.