Tooth loss and tooth decay are more common as we get older. One hundred and seventy-eight million Americans lost one or more teeth in 2015, with more than 35 million losing all of their teeth. Let’s see how Medicare helps in dentures coverage.
Tooth loss can result in various health problems, including a poor diet, discomfort, and a low sense of self-esteem. Dentures are one option for improving your health in multiple ways, including improving your chewing ability, providing support for your jaw, maintaining the structural integrity of your face, and restoring your smile.
Original Medicare does not cover dentures; however, other healthcare options, such as Medicare Advantage and standalone dental insurance, may be able to help pay for or reduce your out-of-pocket costs for dentures.
When does Medicare cover dentures?
If you have a health problem that makes surgical tooth extraction necessary, Medicare may cover some of the costs. Original Medicare does not cover any dentures for any reason (Parts A and B).
Your Medicare Advantage plan may include dental coverage, including dentures; always call your insurance company to see if dentures are covered. For more information on whether or not you are eligible for this coverage, contact your insurance provider.
WHAT SERVICES ARE COVERED BY MEDICARE FOR DENTISTRY?
Normally, Medicare does not cover dental services. There are only a few significant exceptions:
- Oral exams are performed in the hospital before kidney replacement and heart valve surgery.
- Tooth extraction and dental services if deemed necessary to treat a non-dental condition.
- A traumatic accident that necessitated jaw surgery and repair
- As a result of cancer treatment, dental services are required.
If you need dentures, which Medicare plans should you choose?
If you know you’ll need dentures this year, look over your current health insurance to see if switching to a Medicare Advantage plan will help you save money. Separate dental insurance policies may also help you save money on your dentures.
Medicare Part A
Medicare Part A provides inpatient hospital coverage. If you have a health problem that makes it necessary, Medicare Part A may cover an emergency inpatient tooth extraction cost in the hospital. There may be requirements for prosthetic dentures or dental implants due to the procedure, but Part A does not cover it.
Medicare Part B
Part B of Medicare covers outpatient medical treatment, such as doctor’s appointments and preventative care. This Part does not cover dental services such as examinations, cleanings, X-rays, or dental equipment such as dentures.
Medicare’s Part C (Medicare Advantage)
A Medicare Advantage (Part C) plan is a Medicare coverage plan provided by a commercial insurance company. These plans must cover everything that the Original Medicare does, and they often go above and beyond. Your dental services and some or all of the costs of your dentures may be covered under your plan.
Medicare Part D
Medicare Part D is responsible for the coverage of prescription drugs and it requires a separate monthly premium that Original Medicare does not cover. Part D may cover pain medications prescribed after inpatient oral surgery, even though it does not cover dental care.
Medicare supplement plans, also known as Medigap policies, can help you save money on coinsurance, copays, and deductibles by lowering your out-of-pocket costs. Medigap plans can make Medicare more affordable, even though you must pay a monthly fee for the supplement insurance.
Medigap does not extend the coverage provided by Medicare. If you have original Medicare, Medigap coverage will not affect your out-of-pocket costs for dentures.
What are the extra costs for dentures if you are enrolled in Medicare?
Original Medicare does not cover any of the expenses related to dentures. The total cost of your dentures will be your responsibility. However, it may cover a portion of the cost of dentures if you have a Medicare Advantage plan with dental coverage. If you know you’ll need dentures, look into Medicare Advantage plans that include dental coverage to see if they include dentures. You can find out what specific Medicare Advantage covers plan by contacting the insurance provider.
Dentures can cost from $600 to over $8000, depending on the type you choose.
You’ll have to pay for your denture fitting appointment, as well as any follow-ups, diagnostic testing, or other dental appointments. All of this is out-of-pocket unless you have separate dental insurance in addition to Medicare or a Medicare Advantage plan that provides dental coverage.
If you belong to a union, a professional organization, a veteran organization, or a senior citizen organization, you may be eligible for discounts with your dentist. Inquire with your dentist if they are a member of any membership or club discount programs.
Average your dental treatment costs and divide by 12 to get an idea of how much your dental care costs each month. Save money on dentures and dental appointments if you can get dental coverage for less than that.
Part A of Medicare does not cover dentures. Shifting to a Medicare Advantage plan that provides dental coverage during the next Medicare enrollment period may be your best option if you know you’ll need new dentures in the coming year.
Another option you can consider is purchasing private dental insurance.