Original Medicare (Parts A and B) does not provide coverage for dental care, procedures, or supplies.
Medicare Advantage (Part C) plans offer additional services such as dental coverage.
Medicare Advantage plans may not pay the whole amount for your dentures, so you are usually responsible for cost sharing.
If you receive routine dental services in 2022, Original Medicare will not cover these services, including dentures. With few exceptions, Original Medicare does not provide coverage for dental care, procedures, or supplies.
However, there are methods where your Medicare plan may pay for dentures. This is true if you have a Medicare Advantage plan that includes dental coverage for dentures. Because Medicare Advantage is private insurance, the types of coverage can vary by plan.
Keep reading to find out more about Medicare and denture coverage.
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Original Medicare does not traditionally provide for dental coverage. The major exceptions are when you need certain hospital-related dental services. Medicare Part A is typically the Medicare portion that pays for these dental services. Some examples include:
- A cancer diagnosis requires the extraction of a tooth or teeth before removing a tumor.
- Your surgeon requires a dental examination before undergoing a heart valve replacement.
Original Medicare’s minimal dental coverage leaves you without basic dental coverage. An estimated 65% of Medicare beneficiaries have no dental coverage, according to the Kaiser Family Foundation (KFF).
However, an estimated 16% of Medicare beneficiaries obtain dental benefits through Medicare Part C plans, according to KFF. Medicare Part C is also known as Medicare Advantage. Medicare Part C is sold through private insurance companies, and most plans offer at a minimum basic dental coverage. You must be enrolled in Medicare Part A and Part B before you can purchase a Medicare Advantage plan. GoHealth can help you compare plans and prices in your area.
Medicare Part C plans offer additional services such as dental coverage to encourage members to choose their plan. The ability to gain coverage for both Medicare Parts A and B and additional options Original Medicare does not provide (including dental and vision benefits) can make Medicare Advantage plans very advantageous for some people.
However, it’s important to read a Medicare Advantage policy carefully. Companies may structure their policies in several different ways. For example, some dental policies cover only preventive treatments, like annual cleanings or X-rays.
Medicare Advantage policies that cover restorative treatments may offer coverage for dentures. Insurance companies consider restorative treatments as those that can help restore your smile. These include crown placements, dental bonding and dentures.
Medicare Part C policies for dental coverage are truly varied. Often, to obtain dental benefits that extend to restorative services such as dentures, you will pay a monthly premium for your Medicare Part C plan, according to KFF.
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Once you have established a Medicare Advantage plan covering restorative services such as dentures, you should also read how much the plan covers. Some plans will pay a flat rate for specific denture services. Others will pay a percentage of the denture’s costs. You can expect almost all plans will have a maximum benefit they will pay on an annual basis.
Essentially, most Medicare Part C companies will not pay the whole amount for your dentures. You are usually responsible for cost sharing because dentures can be very expensive.
Several denture types exist. These include:
- Partial: Replacing a portion of teeth in the upper or lower jaw.
- Full: Replacing an entire upper or lower row of teeth.
- Removable: Made from specialized plastics for daily removal and cleaning.
- Implant-supported: Typically more expensive because they require initial placement of dental implants in the jawbone to anchor the new denture.
A dentist can provide an estimate of how much your dentures should cost. This can help you calculate what portion, if any, your policy will cover.
According to the American Dental Association, the costs for a full or complete set of dentures range from hundreds to thousands of dollars. Suppose you need a full set of upper and lower dentures and you have a policy that will pay for 40% of denture costs up to $1,000 (when choosing an in-network dentist). If your dentures cost $3,000, you would be responsible for $2,000 of the cost.
Many Medicare Part C companies also limit how often they will pay for dentures. This is why you should carefully read your policy. Some companies will reimburse for new dentures every five years.
Medicare Part C plans are region-specific. This is because an insurance company will often create networks of providers who may offer discounts to insurance companies. Depending upon the costs of care in a particular state or region, a Medicare Advantage plan may reimburse at different amounts or have a different maximum amount they will pay by state.
However, there are no states that prohibit Medicare Part C plans from covering dentures. The insurance company can decide to offer a policy that may include denture coverage.
Speaking of state-specific considerations, some people may have both Medicare and Medicaid. Medicaid is a state- and federally sponsored program that helps pay for care for those below a certain income level. In 2015, 26 states helped pay for dentures through their Medicaid programs, according to the Medicaid and CHIP Payment and Access Commission.
The states where Medicaid pays for dentures include:
The coverage and reimbursement rates for Medicaid will vary by state.
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