Paying for Senior Care: Understanding Medicare and Dentures
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Are you wondering if Medicare covers the cost of dentures? The quick answer is: original Medicare doesn’t provide coverage for most dental services. However, if you need emergency dental care, or medically necessary dental services as part of another procedure, Part A or Part B may provide benefits.
Examples of dental services that may be covered include:
- Surgery necessary to treat jaw or face fracture
- Wiring needed after jaw surgery
- Reconstructive surgery after the removal of a facial tumor
- Oral exam before heart valve replacement
- Oral exam before kidney transplant
- Dental care necessary for radiation treatment
TIP: Use the Plan Finder tool to help you find Medicare Advantage plans that may provide additional benefits such as routine dental care and dentures. Or, get answers to your Medicare-related questions when you pick up the phone and speak with a Licensed Sales Agent: 877-882-1927.
Dental Care for Older Adults
Maintaining healthy teeth and gums throughout life is always important, but it is especially vital as you get older to avoid infections and losing teeth. You can lose teeth at any age as a consequence of health conditions such as temporomandibular joint disorders (TMJ).
Some tooth loss is age-related due to receding gums and decreased jawbone density. If you are a candidate for dentures to replace lost teeth, it’s good to know there are resources available to help.
TIP: Read about dental care for older adults and how to maintain healthy teeth and gums.
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Does Medicare Cover Dentures?
Original Medicare does not cover basic or comprehensive dental care. Dental coverage was excluded from the Medicare and Medicaid Act established in 1965. Although there are many advocates for preventive and comprehensive dental care, adding dental coverage to the Original Medicare program requires congressional approval.
Medicare may make an exception if you need emergency or complex dental procedures while you are a hospital inpatient. You may also qualify for medically necessary dental services related to medical procedures, such as heart surgery and organ transplants.
TIP: Get more of your denture and dental care-related questions answered when you sign up for our newsletter.
Which Medicare Advantage Plans Cover Dentures for Seniors?
If you are new to Medicare and have a dentist you would like to continue using, ask which insurance plans the dental office will accept. They may be contracted as a network provider with certain Medicare Advantage plans.
The most common types of MA plans are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). Both types of plans can offer dental coverage, including Medicare dentures. The main difference between these types of MA plans is flexibility in choosing healthcare providers.
Generally, PPO plans cover out-of-network dentists if you are willing to pay higher out-of-pocket costs. HMO plans may not give you that option. Overall, an HMO plan may cost less as long as you comply with the plan’s requirements, but it depends on your personal needs.
Medical Savings Account (MSA) plans are similar to HSA plans but within the Medicare program. MSA plans are high-deductible Medicare Advantage plans with a savings account you can withdraw from for Medicare-covered expenses. There is no premium for an MSA plan, but you have the option of paying a premium to include dental care as a qualifying expense. This is in addition to the Part B premium.
How Much Do Dentures Cost with Medicare Advantage?
Check your Evidence of Coverage (EOC) for benefits on comprehensive dental care. Some MA plans offer basic benefits only. If your plan covers comprehensive dental, look for coverage of prosthodontics, which includes dentures, implants, crowns and bridges. Depending on the plan, your costs may include a deductible and coinsurance. Your plan may have an annual maximum benefit. The plan may also limit how often you can replace your dentures, typically once every five years.
If you find that your MA plan doesn’t include the comprehensive coverage you’re looking for, you can consider changing plans during an enrollment period. Each year, Medicare recipients can switch plans during the Annual Enrollment Period (AEP). AEP runs from October 15 through December 7. If you already have a Medicare Advantage plan, you can make one change to another plan during the annual Medicare Advantage Open Enrollment Period (OEP). OEP runs from January 1 through March 31. You may also qualify for a Special Enrollment Period (SEP) if you experience certain life events.
Does Medigap Help Pay for Dentures?
Medicare Supplement plans, also known as Medigap, help to lower your out-of-pocket costs for Original Medicare-covered expenses. Medicare Supplement plans cover some deductibles, coinsurance and copayments, depending on the policy purchased. However, they do not offer the extra benefits you find in MA plans. If you are a hospital inpatient and have a Medicare-covered dental procedure while in the hospital, Medigap may cover the Part A coinsurance.
Will Medicaid Help Pay for Dentures?
Medicaid is a federal program administered by the states. If you qualify for Medicaid based on low income and resources, you may be eligible for dental coverage, including dentures, in specific states. However, dental coverage is not federally mandated for adults. Every state is required to provide dental coverage to children in the Medicaid program. According to Medicaid, under half of the states offer comprehensive dental care for adults enrolled in Medicaid. Also, keep in mind that not all dentists accept Medicaid insurance.
At a Glance: Classification of Dental Services
Though Original Medicare does not include most dental services, you may have other options. Before you begin your research, it will help to become familiar with how the marketplace defines basic versus major dental work. This distinction will impact your out-of-pocket cost.
With some variation across insurers, the following is a snapshot of typical classifications:
- Preventive care: oral exams, routine cleanings, X-rays, fluoride application and sealants
- Basic restorative: fillings, root canals, periodontics and extractions
- Major restorative: crowns, dentures and bridges
Generally, the levels of dental insurance coverage correspond to groups of dental services. You can expect the most coverage for preventive or basic services and the highest out-of-pocket cost for restorative or comprehensive services.
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