Does Medicare Cover Dentures? 

Your teeth play an integral role in your overall health. The condition of your teeth can ultimately determine what foods you’re able to eat. This can affect your nutritional intake, mental health, and overall wellness.  Healthy teeth can improve your quality of life. 

Unfortunately, whether due to age, wear, oral health concerns or other factors, seniors often find themselves faced with tooth problems like cavities, broken teeth or gum disease. While many of these problems can be corrected, some require the extraction of teeth. When all teeth have been lost or extracted, dentures can be a solution.

What are dentures?

Dentures are essentially false teeth. Both the upper palate and lower jaw can accommodate separate dentures, so some seniors only need to get one or the other. Immediate dentures may be an option if you have teeth extracted. These are usually made of acrylic. Immediate dentures serve as a temporary set to use while gums heal and gum tissue shrinks after extraction surgery.

Once the gums have healed and shrank into a permanent position, a final denture is cast, usually made from a harder resin material. Today’s dentures look very realistic, and denture adhesive is sometimes used to keep dentures in place during the day or while talking and eating.

Does Medicare help pay for dentures?

People of all ages can suffer from tooth problems, and dentures may be an option for anyone. However, people over 65 tend to require dentures more often than younger people. Many older Americans wonder if Original Medicare covers dentures, and unfortunately, the answer is “no.”

Original Medicare benefits do not include dentures or routine dental work. In fact, Original Medicare coverage does not include a dedicated dental benefit at all. Medicare recipients can obtain coverage for certain medical treatments pertaining to oral health, but the key to this type of coverage is medical necessity.

If, for example, you require surgery to treat cancer in your jaw, Medicare benefits may cover some dental treatments related to repairing the damage caused by cancer and/or the surgery. This is not dental coverage, but because the cancer treatment and surgery are covered by Medicare benefits.  If reconstructive surgery is medically necessary, some or all of the dental reconstruction may be covered.

Covered expenses related to medically necessary dental work will be covered by Medicare Part B if they are provided in an outpatient setting. In the aforementioned example, outpatient surgery is covered by Medicare Part B. Part B expenses usually require Medicare recipients to pay 20% of the total cost of outpatient services after the Part B plan deductible has been met for the year. If treatment is administered while you are admitted to a Medicare-participating hospital or skilled nursing facility, services would be covered under Medicare Part A, the inpatient benefit.

Medication coverage and dental care
It’s important to note that Medicare coverage may apply toward the cost of prescription medications that your dentist prescribed even though dental care is not covered. If you carry Medicare Part D, the prescription drug benefit, your plan will include a formulary that describes the drugs covered by your plan. If your dentist prescribes something, like an antibiotic or pain medication, Medicare will cover the cost under Medicare Part D as long as your medications are listed in your plan’s formulary.

Does Medicare cover dental implants?

Dental implants are a relatively new alternative to traditional dentures, and implants can be installed permanently to take the place of natural teeth and avoid dentures. Unfortunately, Medicare coverage also has no benefit for dental implants, so Medicare recipients would be faced with 100% of the cost if seeking implants as an alternative to dentures.

Medicare Advantage plans may offer a dental benefit

Medicare Advantage plans may provide a dental benefit, but this will vary from provider to provider and from plan to plan. Medicare Advantage plans offer the same coverage as Original Medicare, but they can provide additional benefits like dental, vision and hearing coverage that are not included in Original Medicare. If you’re interested in having your dental coverage included under one umbrella of benefits, a Medicare Advantage plan may be right for you. Compare plans before enrolling.