Medicare is a federal government program that provides health coverage for individuals who are 65 or older, who have been on disability for two years, and those diagnosed with certain conditions like End-Stage Renal Disease (ESRD). The program can be difficult to understand because there are so many working parts.
One question many Medicare beneficiaries ask is, “Does Medicare cover dentures?” Unfortunately, Medicare Parts A and B do not include dentures in their covered services. However, there are other options that might be helpful.
What Medicare plan covers dentures?
There are a couple ways Medicare beneficiaries can get dentures covered by their insurance. One way is with a Medicare Advantage plan and the other is through the PACE program.
Medicare Advantage is also known as Medicare Part C. Advantage plans combine Parts A and B, add in extra benefits, and provide all of that coverage in one plan. The extra benefits often include dental services.
Each Medicare Advantage plan is different because they are offered by private insurance companies. The dental aspect of them will operate much as it would if you had dental insurance through a group or individuals policy. Many Advantage plans cover dentures, but you will need to review the plan’s summary of benefits to find out if dentures are included.
PACE stands for the Program of All-Inclusive Care and it is designed to help individuals get comprehensive healthcare. The eligibility requirements are different from those for Medicare. You can already be on Medicare, Medicaid, or both and still be eligible for the PACE program.
Individuals must be 55 or older, live in a PACE service area, need nursing home care, and be able to safely live in an assisted community. The PACE program includes dental services in it’s coverage, which does include dentures.
Alternatives to Medicare dentures coverage
There are other ways to get denture coverage and make dentures more affordable. Even if your Medicare plan does cover prostheses.
First, you can enroll in an individual, stand-alone dental insurance policy. There are many to choose from, so it may be helpful to work with a licensed independent agent to review your options. Since insurance companies contract with dentists, you may also want to ask your current dentist which insurance companies they are in-network with.
Of course, you can also get dentures without insurance. Most dental offices provide some type of financing and will allow you to make payments over the course of 6 or 12 months. Or, they may offer you a discount for paying in cash at the time of service.
Another popular option is a Dental, Vision, Hearing policy, or a DVH plan for short. As their name implies, these policies offer coverage for all three aspects of healthcare. Medicare does not include routine coverage for dental, vision, or hearing service, so these are helpful to supplement your Medicare Part A and B insurance.
When you are comparing a dental insurance plan, pay close attention to their deductibles, maximum, and coinsurance amounts. If you are looking for denture coverage specifically, usually dentures fall into the “major” category. The most common coinsurance amount for major coverage is 50%, meaning that you and your insurance each pay 50% of the cost for the denture.
Dental discount plans
It is also worth considering dental savings plans. You pay a monthly or annual premium, which qualifies you for discounts. The reduction in the fees varies from 10% to 60%. The only catch is you must see a dentist who accepts the discount plans policy.
How much do dentures cost with Medicare?
If you have a type of Medicare plan that includes denture coverage, the cost will depend on your dentist’s relationship with the plan. Medicare Advantage plans operate on provider networks. If your dentist is in your plan’s network, their fees will be dictated by the insurance company.
Does the original Medicare plan cover dentures?
Original Medicare, known as Medicare A and B, does not cover dentures. Part A is hospital insurance and helps with your room and board expenses during a hospital stay. Part B is outpatient insurance and helps pay for things like visits to your doctor, lab tests, surgeries, etc.
Neither Part included coverage for any dental services, unless they are performed as an emergency service in a hospital setting.
What types of dentures may be covered under Medicare Part C?
The type of dentures covered in your Medicare Part C plan will depend on the benefits outlined in the plan. Some Medicare Advantage plans will cover all types of dentures, including implant-retained dentures, while others are more specific.
If you already have a Part C plan and aren’t sure what your insurance covers, you can ask your dental office to send in a pre-determination to the insurance company. This will tell you exactly what coverage you have and what your financial responsibility will be.