Medicare doesn’t pay for dentures, implants, and other types of dental devices. Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. does pay for certain dental services received if you are hospitalized, but only if the services are medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.. For your denture and routine dental care needs, you’ll need to buy a dental plan or enroll in a Medicare Advantage plan with dental coverage. You can find and compare stand-alone dental plans for seniors here.
Key Takeaways
- Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. does not cover dentures (false teeth) or dental implants.
- Medicare does not cover any routine dental services or oral health services, including cleanings, root canals, tooth extractions, X-rays, fillings, and other restoration work.
- For most Medicare beneficiaries, dental comes out-of-pocket, through a Medicare Advantage plan, or separate insurance.
- For many seniors, the best solution is a Dental Savings Plan.
What Are Dentures?
Dentures are removable dental devices that can replace your teeth. You can get a complete set of dentures if the majority or all of your teeth are gone, or you can get partial sets to replace one or a few missing teeth. Dentures help people with missing teeth to chew and speak more effectively. Most dentures are made to work with dental implants in your lower jaw so they stay in place more easily.1hopkinsmedicine.org, “Dentures“, Accessed November 19, 2021
Why Doesn’t Medicare Pay for Dental?
The initial roadblock for years has been that clinical studies were unable to conclusively prove the link between oral health and overall health, so Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. did not offer routine dental care coverage.
However, recent studies from organizations like the Kaiser Family Foundation have indicated that insufficient preventive dental care can lead to complications with chronic conditions like diabetes and heart disease. Insufficient dental exams can also cause delays in diagnosing these serious conditions and lead to increased emergency room visits over time.2kff.org, “Medicare and Dental Coverage: A Closer Look“, Accessed November 19, 2021
This has caused the House Democrats and organizations like the National Dental Association to push for dental coverage for Medicare and Medicaid beneficiaries. So while currently, Medicare will not cover dental services, such as dentures, you may be seeing this change within the next few years.3npr.org, “Getting dental coverage added to Medicare faces pushback from some dentists“, Accessed November 19, 2021
Related: Dental Insurance for Seniors on Medicare
What’s the real issue?
Many seniors with Medicare benefits fall into a quandary. They enroll in Medicare (original or an Advantage plan) but fail to get dental coverage. Then, when they need dental work, they realize it’s too late because almost all dental insurance policies have a waiting period for restoration work and oral surgery. Plus, most policies have a ridiculously low lifetime and/or annual benefit.4pubmed.ncbi.nlm.nih.gov, “Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries“, Accessed November 19, 2021
Are Medicare Advantage Plans with Dental Worth It?
A few local and national Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). offer dental coverage as part of their plan. Aetna is a classic example. The healthcare network offers dental in employer group plans, and as a stand-alone offering, so bundling it with their premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. Part C plans makes sense. However, savvy seniors should note that there are little or no savings compared with an Advantage plan without dental and individual dental insurance.5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 19, 2021
What’s the Solution?
If you find you’re looking at Medicare Advantage as an option, and you can find a plan provider with dental benefits at a good price, congratulations. The issue for most people is trying to match an HMO or PPO plan with the doctor(s) they like and the medications they use. It’s really difficult. So, really, dental is just a small bonus to everything else working out.
For a growing number of seniors, the best path is a dental discount plan, also known as a dental savings plan. It’s not insurance. It’s a per-negotiated discount in the range of 20-60 percent on just about every dental procedure you can imagine. The cost is very modest; around $120 to $150 per year for an individual or $170 to $200 for you and your spouse. Plus, there are no waits, no limits, and no claims forms to deal with, just easy peasy cost savings.6Cigna.com, “Discount Dental Programs“, Accessed November 17, 2021
Not convinced? Savings plans are offered by some of the largest names in healthcare, including CVS, Aetna, Cigna, Aon, and many more. See all of your options on our Dental Plans and Insurance for Seniors page.
Citations
- 1hopkinsmedicine.org, “Dentures“, Accessed November 19, 2021
- 2kff.org, “Medicare and Dental Coverage: A Closer Look“, Accessed November 19, 2021
- 3npr.org, “Getting dental coverage added to Medicare faces pushback from some dentists“, Accessed November 19, 2021
- 4pubmed.ncbi.nlm.nih.gov, “Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries“, Accessed November 19, 2021
- 5Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 19, 2021
- 6Cigna.com, “Discount Dental Programs“, Accessed November 17, 2021