How do i get medicare to pay for dentures

Sometimes, Medicare Advantage (often called Part C) plans are approved by the federal government and sold by private insurance companies. These plans often offer services not covered by Original Medicare, such as dental, vision and hearing coverage, says Christian Worstell, a North Carolina-based licensed insurance agent. Enrollees might pay an extra premium for these benefits. However, not all Medicare Advantage plans offer dental coverage, so it’s important to read your plan’s details carefully.

Medicare Advantage plans tend to be the best way to get dental coverage, but you can also buy a separate dental plan offered by a private insurance company, says Worstells.

What Does Medicare Dental Coverage Include?

Exactly what dental coverage includes varies depending on the Medicare Advantage plan you choose.

Aetna Medicare Advantage, for example, offers three types of dental coverage:

• Network: Preventative services, such as dental cleanings and X-rays, are covered.
• Direct member reimbursement allowance: You pay upfront for your dental care and then submit receipts for reimbursement (up to a certain amount).
• Optional supplemental benefits: You can purchase dental benefits for an extra premium each month.

What Does Dental Coverage Cost?

Generally, the cost of Medicare Advantage plans and dental coverage specifically in cases where there’s an extra premium involved vary based on factors like your age and where you live. Some have a $0 monthly premium while others cost more. In eastern Pennsylvania, for example, Medicare Advantage plan premiums range from $0 to $302 a month. In the Los Angeles area, they range from $0 to $397 a month.

Low-cost Medicare Advantage plans that don’t include an extra monthly premium for dental coverage typically include basic dental services, such as checkups and cleanings, says Worstell.

“The more expensive plans [with higher premiums] include coverage of more advanced dental services like extractions and dentures and other things more relevant to older patients.”

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Original Medicare does not cover the cost of dentures or related care. When searching for denture coverage, we suggest starting with Medicare Advantage.

If you need coverage for dentures, a Medicare Advantage plan is a good place to start since many of these plans provide both dental and denture benefits.

If you'd rather stay with Original Medicare, you may want to look into a stand-alone dental plan that includes coverage for dentures or dental implants. You'll pay a separate monthly fee and other out-of-pocket charges, but the coverage may be worth the cost.

• Does Medicare cover dentures or implants?
• Does Medicare Advantage cover dentures?
• Best stand-alone plans for denture coverage

Does Medicare cover dentures or implants?

Original Medicare does not cover any charges related to dentures or dental implants. This is the case even if you require surgery to repair your jaw after an accident. While Medicare may pay for the surgery, it won't cover dentures or dental implants you may need afterward.

To get coverage for dentures, you'll need a Medicare Advantage plan or a stand-alone dental policy.

Does Medicare Advantage cover dentures?

Many Medicare Advantage plans cover dentures, implants and related needs along with routine dental care.

But costs and benefits vary by plan: For example, some Medicare Advantage insurers include dentures in their standard dental coverage, while others charge extra for denture benefits. Many insurers refer to the added benefits as "enhanced" or "comprehensive" dental coverage.

How does Medicare Advantage denture coverage work?

Many Medicare Advantage plans include both dental and denture coverage as a standard benefit. But some plans treat dentures as an optional benefit and may charge a higher monthly rate for those services.

Plans that provide denture benefits often have an annual coverage limit, typically between $1,000 and $2,000, ?and allow for new or replacement dentures once every five years. You may be charged a flat fee or copay for your dentures or pay a percentage of the cost — also known as coinsurance.

Medicare Advantage plans may cover removable dentures, implants or both. Before deciding on a plan, you may want to ask your dentist which type of dentures you'll need to be sure they will be covered.

Best Medicare Advantage plans for dentures

If you're shopping for a Medicare Advantage policy and want coverage for dentures, implants or other specialty dental care, your best bet is a Cigna plan.

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One of Cigna's $0-premium HMOs provides coverage for full upper and lower removable dentures at a reasonable copayment of $575 for each set, and partial dentures for $430. This Cigna policy also covers implants, which not all plans do. Cigna has no annual benefit limit, but like most plans, Cigna only covers new or replacement dentures every five years.

Other Medicare Advantage plans provide denture coverage, but costs and benefits can vary. For example, Humana members pay 70% of the cost of dentures and related services, while Kaiser Permanente copays are higher than what competitors charge. And Aetna's $0-premium plan only gives a yearly benefit of $250 — a small amount considering the cost of dentures and implants.

These plans also may require you to buy enhanced coverage with higher rates than some stand-alone dental plans.

Company

Max yearly benefit

Added monthly rate

Medicare rating

Best stand-alone plans for denture coverage

The best stand-alone plans for dentures and other specialty services are offered by Delta Dental and Humana. Along with specialty care, these policies cover preventive dental services such as cleanings and X-rays. Neither plan charges a deductible or has an annual benefit limit.

Delta Dental offers a plan costing $12.50 per month plus a $10 annual enrollment fee. The plan does not cover implants but does provide benefits for denture repair, complete dentures and crowns.

One of Humana's dental plans costs $15 per month plus a $35 yearly enrollment fee. The plan covers implants, crowns and dentures.

Delta Dental: Good for low costs

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Humana Dental: Good for implants

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Availability, rates and benefits for stand-alone plans will vary by location. Most dental plans work with a specific provider network, so if you have a particular provider in mind, you may want to check the provider listing before you enroll.

Frequently asked questions

Does Medicare cover dentures for seniors?

Medicare does not cover the cost of dentures for Medicare enrollees of any age. If you're eligible for Medicare and need dentures, you may want to look into Medicare Advantage or a separate dental insurance plan.

How do Medigap plans cover dentures?

Medigap policies only pay their share of charges if Medicare covers the services. Since Medicare does not cover dentures, Medigap plans do not pay for denture supplies or services.

Does Medicare pay for permanent teeth?

No, Medicare does not pay for permanent teeth or dental implants. But a Medicare Advantage plan or a free-standing dental policy may cover the cost of implants.

Methodology

Medicare Advantage dental coverage data was sourced from AARP/UnitedHealthcare, Aetna, Anthem, Cigna, Humana and Kaiser Permanente. Information on Original Medicare coverage for dental services was obtained from Medicare.gov. For stand-alone dental coverage, we reviewed a variety of plan sites including those for Delta Dental and Humana Dental.

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Deductibles, copays, coinsurance, limitations, and exclusions may apply.

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