Dentures can aid in eating and speaking if a person experiences tooth loss. However, Medicare does not cover the costs of dental care except in limited circumstances.
According to the Kaiser Family Foundation (KFF), 15% of Medicare enrollees have no natural teeth.
This article discusses Medicare dental benefits, including coverage for dentures. It also looks at costs and options for financial aid.
Medicare is a federal insurance program designed to provide health care to people who are aged 65 and older. It is also available to a younger person with a disability or certain medical conditions, such as end-stage renal disease and amyotrophic lateral sclerosis.
The Medicare program has four parts:
- Part A hospital insurance
- Part B medical insurance
- Part C, Medicare Advantage, which offers an alternative to original Medicare (Part A and Part B)
- Part D prescription drug insurance
Medicare negotiates prices with hospitals, doctors, and insurance companies.
Most dental coverage related to Medicare is for emergency dental services performed while a person is in a hospital. For example, if a person had oral cancer and required dental extractions before an oral surgeon could remove a cancerous area.
Original Medicare does not cover dental cleanings, fillings, plates, dentures, or tooth extractions.
However, although original Medicare does not cover the cost of dentures, a person might get coverage through a Medicare Advantage (Part C) plan.
Some Medicare Advantage plans offer additional services, including dental, hearing, and vision coverage.
An estimated 34% of people enrolled in Medicare have Medicare Advantage plans, according to KFF.
A few key points may indicate if a Medicare Advantage plan might offer coverage for dentures.
Preventive versus comprehensive
Preventive dental services include cleanings, fillings, and some extractions. Comprehensive services usually include more extensive dental work, such as partial or full dentures. Some Medicare Advantage plans offer coverage for preventive services only.
In-network versus out-of-network
Medicare Advantage plans (especially Preferred Provider Organizations or PPOs) often require a person to see dentists in the company’s network before the plan will pay. A person should ensure their dental provider of choice is included in this provider network.
Co-pays and co-insurances
Some Medicare Advantage plans will pay for a portion of dental costs. For example, they may pay between 30% and 50% of the costs for dentures. Others offer a maximum benefit, paying for all costs up to a certain amount.
Most Medicare Advantage plans will have a cap or maximum benefit of costs they will cover for dental services. This may range from $200 to several thousands of dollars. Also, some companies may limit how often they will pay for denture replacements. Because dentures can be very expensive, it’s important to consider the maximum benefit when selecting a plan.
There are several types of dentures and costs vary depending on several factors such as type of denture, materials, and quality.
Fixed versus removable dentures
Fixed dentures are secured to the mouth with dental implants, which are surgically implanted posts into the jaw. Removable dentures can be taken out on a daily basis, cleaned, and put back in daily. Fixed dentures are costlier due to the more-extensive process to secure and create them.
Partial or full dentures
Full dentures give the look of replacing every tooth in the upper or lower portion of the mouth. Partial dentures may replace several missing teeth in the upper or lower jaw.
Dentures may be made from acrylic resin (plastic) or porcelain. Partial dentures also have some metal components. As a general rule, porcelain dentures are slightly more expensive but may be more durable than their acrylic resin counterparts.
Dentures can vary in cost and quality. According to Bankrate.com, some of the potential costs for dentures include:
- Low-cost dentures range from $300–$500 for an upper or lower set to $600–$1,000 for a complete set.
- Mid-priced dentures typically use higher quality materials and may look more natural. Costs range from $500–$1,000 per upper or lower to $1,000 –$3,000 for a complete set.
- Premium dentures use the highest quality materials and techniques to create a long-lasting denture. Costs range from $2,000–$4,000 per upper or lower denture to $4,000–$8,000 for a complete set.
Medicare Advantage plans offer various types of coverage for dental services. Most plans will not cover the full denture costs.
Some plan coverage and cost examples, using the Find a Medicare Plan tool, are shown in the chart below.
|City, State||Plan name||Costs||Denture coverage||Maximum benefit|
|Trenton, New Jersey||HumanaChoice PPO Medicare Advantage Plan||$0 monthly premium with $34.90 to add ‘optional supplemental benefits’ that includes dental||A person pays 70% of denture costs for in-network and 75% of costs for out-of-network||$2,000 per calendar year|
|Tulsa, Oklahom||Aetna Medicare Freedom Core Plan (PPO)||$0 monthly premium||$200 annually toward comprehensive or preventive services||$200 per calendar year|
|Dallas, Texas:||AllWell Medicare HMO||$0 monthly premium||$50 in-network deductible, then a person pays a 30% coinsurance for denture costs||$1,000 per calendar year|
|San Diego, California||Anthem MediBlue Extra (HMO)||$14.40 monthly premium||$250 comprehensive coverage per quarter||$1,000 per calendar year|
|Tampa, Florida||WellCare Premier (PPO)||$0 monthly premium||70% of the prosthodontics service||$1,000 per calendar year|
There are other options a person may access to get dental coverage or reduced dental costs:
Nearby dental schools/clinics
Some dental schools or clinics have a prosthodontics department, where students learn to fit dentures. These schools may offer discounted dentures or services in preparation for molding the dentures.
Standalone dental plans
Some health insurance companies offer standalone dental plans for older people. For a monthly premium, a person may get coverage similar to or greater than Medicare Advantage plans.
Discount dental plans
These plans are offered through organizations that make dentures or provide dental care. They have a network of providers where a person can get discounted services on comprehensive dental needs, including dentures.
Medicaid is a state-based insurance plan for people on lower incomes, and some states may provide additional coverage for dental services, which may include dentures. However, these benefits vary by state.
While original Medicare does not offer coverage for dentures, Medicare Advantage plans may help pay for costs. However, most Advantage plans may not fully pay for dentures, even with maximum benefits.
If a person does not get dental coverage through a Medicare Advantage plan, there are other options that may help with the cost of dentures.