- Medicare Parts A and B do not cover dentures. Medicare beneficiaries can cover the costs of dentures through a Medicare Advantage plan or the PACE program.
- A Medicare Advantage plan includes dental services. Coverage depends on the plan's summary of benefits.
- The PACE program is for individuals who are at least 55 years old and need nursing home care. It includes dental services and covers dentures.
Use Authority Dental to book an appointment for the same day dentures, or get a dental plan and save up to 60% on all dental procedures, including dentures.
Is it possible to lower the cost of dentures with Medicare? Here's everything you need to know.
What Medicare plan covers dentures?
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"One of the most challenging conversations I have in my practice is with patients who are about to lose their teeth and are counting on Medicare to help them," Harry Lee, DMD, says.
"They are often shocked and heartbroken to learn that Original Medicare does not cover dentures. It is a devastating blind spot in our healthcare system that treats the mouth as if it were separate from the rest of the body. This is not a simple oversight; it reflects how dentistry has historically been separated from medicine," he adds.
However, there are a couple of 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
Medicare Advantage, also known as Medicare Part C, combines Parts A and B, adds extra benefits, and provides all that coverage in one plan. The extra benefits often include dental services.
Each Medicare Advantage plan is different because a private insurance company offers it. The dental aspect of them will operate much as it would if you had dental insurance through a group or individual policy. Many Advantage plans cover dentures, but you will need to review the plan’s summary of benefits to find out if dentures or affordable denture repair are included.
PACE program
PACE stands for the Program of All-Inclusive Care, which is designed to help individuals access 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 live in an assisted community safely. The PACE program covers dental services, including dentures.
Alternatives to Medicare dentures coverage
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There are other ways to get denture coverage and make dentures more affordable, even if your Medicare plan does cover prostheses.
Insurance
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 ask your current dentist which insurance companies they are in-network with.
Of course, you can also get dentures without insurance. Most dental offices offer financing and allow you to make payments over 6 or 12 months. Alternatively, they may offer you a discount for paying in cash at the time of service.
DVH plan
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 services, so these are helpful to supplement your Medicare Part A and B insurance.
When comparing dental insurance plans, please pay close attention to their deductibles, maximums, and coinsurance amounts. If you are specifically looking for denture coverage, dentures usually fall into the “major” category. The most common coinsurance amount for primary 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 fee reduction ranges from 10% to 60%. The only catch is that you must see a dentist who accepts the discount plan's policy.
FAQ
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 are set by the insurance company.
Does the original Medicare plan cover dentures?
Original Medicare (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 that helps pay for visits to your doctor, lab tests, surgeries, etc.
Neither Part included coverage for any dental services, unless they were performed as emergency services 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 are not 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.
Harry Lee, DMD
While Medicare will cover a hip replacement to help you walk, it will not cover the dentures you need to eat. From a health perspective, this makes no sense. The inability to chew properly leads directly to poor nutrition, which can worsen other chronic health conditions like diabetes and heart disease. It is a critical, medically necessary function that gets overlooked. This is why we spend so much time counseling patients on the importance of proactively seeking out specific Medicare Advantage (Part C) plans. These are private insurance plans that often include dental benefits.