Does Medicare Or Insurance Cover Dental Care?

If you’ve recently been told by a Dentist that you may need to get dentures, the first thought in your mind is likely how much it will cost. If you think you are going to be fine if you have Medicare coverage or dental insurance, thing again. Not everything is at it seems. Read further to find out more.

Dentures and Private Dental Insurance

For those with private dental insurance, you will be happy to know that most major dental insurance policies do cover dentures, according to investopedia.com, an online resource for reliable financial information. While this is good news, there are a few caveats worth noting.

Although the process of being fitted with dentures is a major procedure, which is covered by dental insurance providers, most policies only cover 50 percent of the associated treatment cost. And the 50 percent that is covered is subtracted from the policy’s annual maximum coverage limit.

In simple terms, this means that some individuals might have to pay out-of-pocket for any additional dental procedures they might need after getting their dentures. And those who previously used their policy to cover the cost of other treatments will likely not have their dentures covered at 50 percent since the total amount covered is based on how much of the annual maximum coverage limit has already been exhausted.

How Are Annual Maximum Coverage Limits for Dental Insurance Determined?

According to costhelper.com, an online resource for objective price information on thousands of goods and services, the cost associated with basic dentures average between $600 and $1,000, which includes a full set of upper and lower teeth.

Complete mid-range dentures, on the other hand, are slightly more expensive as most can expect to spend 1,000 to $3,000 for a full set. Lastly, partial dentures are between $700 to $1,800. Given these prices, it is not too surprising to find that many people are turning to their dental insurance to help cover the cost of dentures.

Generally speaking, annual maximum coverage limits are determined based on a three-tier structure whereby an individual’s dental policy will cover a given procedure at 100, 80, or 50 percent. To put this into perspective, preventative care, which primarily consists of cleanings and x-rays, is covered 100 percent while fillings, extractions, periodontal treatments, and the like are covered 80 percent.

Major procedures, on the other hand, some of which include crowns, bridges, and dentures, for example, are covered 50 percent. If an individual has already had several non-preventative procedures billed to their insurance, they may have to pay a significant co-pay for their dentures. There is also a chance that they might not be covered under their policy at all.

It is also worth noting many major insurance providers have a waiting period for new patients. More often than not, these patients will have to wait at least 12 months before their insurance provider will cover any non-preventative treatments under their policy.

Dentures and Medicare

Although getting dentures covered under dental insurance can present some challenges, it is not impossible. Original Medicare, however, is another matter entirely. According to medicare.gov, the original federal health insurance program does not cover dental care.

In fact, the website explicitly states that cleanings, fillings, tooth extractions, and dentures are not covered. However, this does not mean that individuals have to go without getting the care that they need.

Medicare Part A, which an individual must sign up for when enrolling in Social Security, will cover dentures and a few other major dental procedures that are deemed an emergency and performed at a hospital.

Medicare Part C, on the other hand, covers many of the same dental procedures covered by traditional dental insurance. And these plans, also known as Medicare Advantage plans, do not require hospitalization as a condition of eligibility for coverage. That said, Medicare Part C covers the following:

  • General teeth cleaning

  • Dental fillings

  • Extractions

  • X-rays

  • Dentures and some other major dental procedures

To qualify for Medicare Part C, an individual must be meet one or more of the following:

  • Enrolled in Original Medicare

  • Age 65 or over

  • A disabled U.S. citizen or legal permanent resident

  • Diagnosed with Lou Gehrig’s Disease

  • Diagnosed with end-stage kidney disease

Bottom Line

In summary, it is entirely possible to have partial or complete dentures covered under private dental insurance or by Medicare Part A or Part C. However, understanding the specifics of private and federal insurance coverage is no easy feat. Therefore, those who need dentures and are interested in having them covered under any form of insurance should carefully review their policy before scheduling a dentist appointment.

It may also be a good idea to speak with an insurance representative to get more information on annual maximum coverage limits, co-pays, deductibles, and other factors associated with getting dentures or undergoing any other dental procedure.