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Medicare Coverage of Dentures


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Medicare doesn’t cover most routine dental care or supplies, including oral exams, cleanings, fillings, extractions, and dental appliances, including dentures.

In some situations, you may be covered for extractions or oral exams when they’re related to a covered procedure. For example, Medicare covers oral exams if they’re part of a pre-op exam prior to getting kidney transplant surgery or a heart valve replacement. You’ll also be covered for teeth extractions when they’re needed to prepare your mouth for radiation (for example, to treat oral cancer). However, Medicare won’t cover dentures or fittings for dentures you may need after the tooth extractions.

You’ll typically have to pay the full cost out of pocket for dental care and dentures unless you have other insurance.

Medicare Part C coverage of dentures

Some Medicare Advantage plans may cover additional benefits that Original Medicare doesn’t cover. Also known as Medicare Part C, the Medicare Advantage program offers an alternative way to get your Original Mdedicare benefits. Medicare Advantage plans are available through private insurance companies that are approved by Medicare and are required to offer at least the same level of coverage as the federal program. However, many Medicare Advantage plans offer coverage beyond Original Medicare, which may include routine dental services and dentures. Since coverage can vary from plan to plan, always double-check with the Medicare Advantage plan you’re considering to see if a specific benefit is included.

PACE programs and coverage of dentures

Program of All-inclusive Care for the Elderly (PACE) may be another way to cover some of the cost if you need dentures. PACE is a program jointly run by Medicare and Medicaid that provides health-care services for individuals in their homes and communities. The program is focused on helping older adults remain independent and prolong nursing-home care for as long as possible.

PACE provides all services that are covered by Medicare or Medicaid, and dental services may be covered under your state’s Medicaid program. If you are interested in learning more about PACE, visit www.Pace4You.org for more information.

Alternative ways to pay for dentures

If you don’t have a Medicare Advantage plan and aren’t eligible for PACE, you may have other ways to pay for the costs. Keep in mind that the options below are separate from the Medicare program.

  • Medicaid: Dental services and dentures may be covered by Medicaid in your state. Medicaid programs are state-run, and individual states are free to expand their programs beyond federal guidelines. Dental care and dentures are optional benefits, so not every state covers them. If you have limited income and qualify for Medicaid, contact your state’s Medicaid department to learn if dentures are covered.
  • Dental insurance: Many major medical health plans include dental coverage, but stand-alone dental plans may also be available in your state. These plans typically cover oral exams, cleanings, X-rays, fillings, and other preventive dental care. Plans may also help with some of the costs for oral surgery, implants, and dentures. Benefits will vary by plan, so check with the specific plan for more details. You can start browsing dental plans in your location using eHealth’s plan finder tool.
  • Dental schools: Some dental schools may run low-cost clinics as a way to give back to the community and train dentists. Find dental schools near you to see if programs are available in your location.
  • Community health clinics: Local community centers may provide dental services for low-income individuals. The National Council on Aging and Eldercare Locator can help you find resources for seniors in your area.
  • Dental Lifeline Network: This program provides free dental services to vulnerable groups who can’t afford care, including seniors and disabled individuals. Find out if you’re eligible and look up the program for your state by visiting the Dental Lifeline Network website.

 

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

 

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