What Medicare Plan Covers Dentures?
A full set of adult teeth amounts to 32 teeth – that includes the wisdom teeth. According to the National Institute of Dental and Craniofacial Research, 27.27% of seniors over age 65 have no teeth remaining. You’re not alone!
Dentures are prosthetic devices designed to replace missing teeth. Traditional dentures are removable – these are often the dentures you see in movies that are always falling out and embarrassing the older folks at the dinner table.
However, technology is always advancing, and there are now many types of denture designs. Dean Cosmetic Dentistry Center explains that implant-supported dentures can’t slip off the gums, and they don’t require adhesive to stay in place. They attach to dental implants, and you can even remove them for cleaning. There are also other options, like mini dental implants, which are minimally invasive and are less expensive.
Either way, there are fantastic options that’ll give you back your smile! The question is, at what price?
Will Medicare Ever Pay for Dental Benefits?
Medicare doesn’t cover most dental care, and they definitely don’t cover dentures. This comes as a shock to many who are new to Medicare.
Every dentist will tell you that your oral health impacts your overall health. Research shows links between poor oral health and chronic disease like diabetes. Poor oral health also leads to pain, infection, and a poorer quality of life.
Many politicians and activist groups have been fighting for a comprehensive dental benefit to be added to Medicare Part B. According to the American Dental Association estimates, adding this benefit would cost the federal government $32.3 billion in 2018 (Reuters). Ultimately, adding dental benefits would increase the Part B premium by $14.50 per month for everyone on Medicare.
Most experts will tell you they don’t expect Medicare to cover dental bills anytime in the near future, if ever.
If Medicare doesn’t cover dentures and other dental care, what about Medigap, Medicare Advantage, and other Medicare insurance plans?
Medicare Supplements and Dentures
Medicare Supplements, also called Medigap plans, simply supplement Medicare. Medicare might pay for 80% of a service, and the supplement will pick up the remaining 20%. If Medicare doesn’t cover an item, treatment, or service, the supplement won’t either. They work together.
Medicare doesn’t cover dentures, which means Medicare Supplements don’t cover dentures either.
In fact, Medicare doesn’t cover most dental services. If you were hoping Medicare might cover preventive services, like cleanings or fillings, you’ll be disappointed.
Medicare Part A, your hospital insurance, will pay for certain dental services you get if you’re hospitalized, but other than that, you’ll need to pay out of pocket for dental care.
Medicare Advantage and Dentures
Medicare Advantage (MA) plans often do include some dental benefits, though it can be pretty rudimentary. It’s typical for an MA plan to offer a free annual cleaning, a free annual exam, a round of X-rays, and a low copay for common dental procedures.
However, dentures and other more involved dental services are either partly covered or not covered at all. One Aetna PPO offers a total of $750 every year for preventive and comprehensive dental services. The cost of dentures can cost up to $350 per tooth, so that maximum benefit could still leave you with major out of pocket expenses.
One Florida Blue HMO covers 2 denture adjustments per year for a $0 copay, but the actual dentures are not covered at all.
In sum, a Medicare Advantage plan can offer some nice preventive dental benefits, but if you’re looking for great denture coverage, they leave much to be desired.
Most MA plans also have a reimbursement structure. You would pay for the dental service and submit the paperwork to your plan. Reimbursements can take up to 45 days, and if you missed any information, the plan can come back and ask for more paperwork and information. If you’ve ever had to deal with submitting paperwork to insurance companies, you know this can be a major headache that results in a lot of back-and-forths.
The other tricky part about MA plans is they’re all different, and plans can change each year. You may want to check the plans available in your county by visiting Medicare’s Plan Finder tool.
You should know the plans in your county are different from other counties. Just because your friend or loved one recommends their plan doesn’t mean it’ll be the same plan with the same benefits where you live.
When you find a plan you’re interested in, be sure to read what’s covered, which you’ll find in the Evidence of Coverage document. You’ll also want to pay special attention to your network, as MA plans are network-based.
There are simply more hurdles to go through when dealing with MA plans, though you may get some dental coverage, which Medicare Supplements do not offer.
Medicare MSA and Dentures
The Medicare MSA gives you money in the form of an annual deposit, typically between $2-3,000 per year. You can use that deposit for any qualified medical expense, which includes services and treatments not covered by Medicare. However, only Medicare-approved expenses count toward the high deductible.
In plain language, you can purchase dentures with an MSA - it just won't count towards your deductible. In 2019, 84% of Lasso Healthcare MSA members still had money left in their account, so historically, reaching the high deductible hasn’t been a major concern.
With the MSA, there are no provider networks, but it’s still recommended you call first to make sure your card will be accepted. However, since dentures are not a Medicare-approved expense, you don’t need to call your dental provider first. You’d simply use your MSA debit card to pay for the service. Be sure to ask for a discount!
Dentures and Senior Dental Insurance
Many private insurance companies offer dental insurance since many seniors want it, and Medicare doesn’t cover it.
Here at Medicare Allies, we offer dental insurance plans from Aetna, Ameritas, United National Life, Renaissance, Medico, and Mutual of Omaha. Many of these plans also come with vision or hearing benefits.
A dental insurance plan can help you pay for expensive dentures. Many plans offer to pay up to half of your denture costs up to a maximum annual benefit. That could greatly reduce your out-of-pocket costs. In addition, most dental plans pay for all diagnostic and preventive dental care, including cleanings and X-rays.
If you’re concerned about how much dentures will cost and want to save up, Mutual of Omaha dental plans come with a pretreatment estimate service, where you can call 800-775-1000 and find out how much your dentures would cost. You can also ask your dentist for an estimate.
Dental insurance is inexpensive. For a 70-year-old, you’re looking at as low as $35 per month. If you’d like a quote for dental insurance, fill out our Get a Quote form.
Medicare does not offer coverage for dentures, which means Medicare Supplements also don’t by default. Medicare Advantage plans do come with some dental benefits, but they’re often capped and sometimes don’t cover major services at all. If you have a Medicare MSA, you can use your annual deposit to pay for dentures – it just won’t count toward your deductible.
A dental insurance policy can help you pay for more expensive services like dentures, but you’ll still have out-of-pocket costs.
We often tell our clients to keep a small fund set aside for dental, vision, and hearing expenses. We offer dental insurance plans to greatly reduce your exposure, but you will still face out-of-pocket costs if it’s a major service or treatment. One of our clients says he has a jar, and every time he has a $5 bill, he adds it to the jar. It adds up over time, and you hardly notice it!
We hope this helps, and if you’d like to get a quote for dental insurance, be sure to call us at 833-801-7999 or fill out our Get a Quote form.
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