Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Insurance coverage for dental benefits helps make dental care and dentures more affordable. Dentures are not a Medicare-covered service – though the law may soon expand Medicare to include dental care. Currently, the only Medicare coverage for dentures is through a Medicare Advantage Plan as an additional benefit.
Other ways to get denture coverage are by accessing your community resources, government-funded programs, and discount dental or insurance plans. Properly fitting dentures are an investment you make for your quality of life and the ability to talk and chew food without pain. Unless you are eligible for free dental care, there are costs associated with dentures, even with insurance and discounts.
Does Medicare Ever Cover Dentures?
According to the Kaiser Family Foundation (KFF), if you are enrolled in a Medicare Advantage Plan in 2021, chances are high (86%) that you have access to preventive and extensive dental care, including dentures. Policymakers have proposed an expansion to Medicare to include dental coverage under Part B, but as of 2021, dentures are a non-covered service.
|Medicare Denture Coverage|
|Original Medicare||Medicare Advantage Plans|
|Not covered||Covered as an additional benefit on many plans.|
Which Medicare Plans Cover Dentures?
Medicare Advantage Plans may cover dentures as an additional benefit. Advantage plans are the leading source of dental coverage for seniors on Medicare. Dentures fall under the heading of extensive dental services versus preventative or routine services such as exams and teeth cleaning. Most often, if you need dentures and have a Medicare Advantage Plan, you:
- Must see a dental provider in your plan’s network.
- Will have a coverage limit. The average annual allowance for dental services in 2021 is $1,300.
- Will pay a coinsurance. The average coinsurance for extensive dental services, like dentures, is 50% of the total cost.
- May have to pay an additional monthly premium for extensive dental coverage.
- Are typically eligible for a new set of dentures every five years.
If you need dentures, you will incur out-of-pocket expenses. Properly fitting dentures are essential to your overall health and quality of life, so you want to make sure you get dentures that fit you. Talk with your plan and dental provider to discuss your options. You can shop for Medicare Advantage Plans with dental coverage that is affordable for you here.
When Does Medicare Cover Dental Services?
Medicare Part A (hospital insurance) will cover emergency or complicated dental services you receive in the hospital. For instance, if you have an accident or have mouth cancer, Medicare may pay for surgery or tooth extraction necessary to treat your medical condition. Follow-up dental care, however, would not be covered.
Part B may pay for a dental exam that is required before you have a procedure done, like open-heart surgery. Original Medicare dental coverage for services like these are limited in nature and only apply to situations where you have an underlying health condition or procedure that must be supported by proper dental care.
Other dental services such as routine exams, teeth cleanings, fillings, dentures, and denture supplies are not covered by Original Medicare. Some Medicare Advantage Plans offer dental services as an additional benefit.
|Medicare Dental Coverage|
|Medicare||Medicare Advantage Plans|
|Hospital emergency dental||Yes||Covered as an additional benefit on many plans.|
|Routine dental exam||Only if required before a procedure, such as open-heart surgery||Covered as an additional benefit on many plans.|
|Dental care such as cleaning, fillings||Not covered||Covered as an additional benefit on many plans.|
|Dentures||Not covered||Covered as an additional benefit on many plans.|
What Are Alternative Ways to Get Coverage for Dentures?
There are other ways to get coverage for dentures. Community resources can help you find coverage or financial assistance to help pay for dentures. Here are some options:
- Purchase stand-alone dental insurance through a private insurance company. You pay a monthly premium and a share of the costs in the form of deductibles and coinsurance, or copays. Rates and benefits vary depending on which plan you choose. You can search online or speak with a licensed insurance agent to find a plan that includes denture coverage.
- Join a discount dental plan. This is not insurance, but for an annual fee, you can receive dental services at a discounted rate if you use in-network providers. Talk with your current dental provider about which discount plans they accept. Some Medicare Supplement Insurance Plans (Medigap) plans offer members access to a discount dental plan through a specific provider.
- If you are a veteran, you may be eligible for free or reduced-cost dental care or insurance. Search here for more information from the U.S. Department of Veteran Affairs.
- Medicaid dental benefits if you are eligible. The Center for Health Care Strategies, Inc. (CHCS) has published a resource of fact sheets to help you learn about Medicaid adult dental benefits coverage by state. Find your state and explore your options here. Or contact your state Medicaid agency here.
- Speak with a representative from your local Area Agency on Aging office to determine which dental providers offer discounts and dental care to seniors in your community.
Learn More From Our Sources
- CHCS | Medicaid Adult Dental Benefits Coverage by State | Last accessed September 2021
- KFF | Medicare and Dental Coverage: A Closer Look | Last accessed September 2021
- Medicaid | Contact Your State Medicaid Office | Last accessed September 2021
- Medicare | Dental Services | Last accessed September 2021
- Medicare | Medicare Advantage Plans | Last accessed September 2021
- Medicare | Original Medicare | Last accessed September 2021
- Medicare | Find and Compare Plans | Last accessed September 2021
- USAging | Find Your Local Area Agency on Aging | Last accessed September 2021
- US Department of Veteran Affairs | VA: Dental Care | Last accessed September 2021