Many retirees want to know if Medicare will cover the cost of dentures. Medicare provides comprehensive healthcare but offers notably limited dental care benefits. This article delves into the extent of dental coverage under Medicare, shedding light on the options available for individuals seeking dental care.
The Scope of Medicare Dental Coverage
Medicare, established in 1965, was not designed to cover routine dental care, including dentures. At that time, authorities did not consider dental care routine medical care.
A 1980 Congress statute highly restricts Medicare’s dental coverage due to a dental exclusion. As a result, Medicare seldom covers dental procedures like extractions and fillings, which are essential for maintaining oral health.
Medicare does not cover denture costs, deeming them not medically necessary under Parts A and B.
Will Dental Ever Be Covered Under Medicare?
Factors prevent the inclusion of dental benefits under Medicare, despite widespread desire. It is important to keep in mind that there are almost 66,000,000 people on Medicare.1 Yes, you read that correctly….66 million!
To cover one dental visit of $120.00 for each Medicare beneficiary, taxpayers would have to fund an additional $7,920,000,000.00 into Medicare. Taxpayer dollars fund programs like Medicare and Social Security, as we all know.
So where do we come up with another $8 billion dollars to cover $120 per person in dental bills? If you answered raising taxes, then you are on the right page.
So how much are dentures. Roughly a complete set of ‘mid-priced’ dentures costs between $1,000 – $3,000. A single denture plate can run between $500 – $1,500.2
Just using these costs for a complete set of ‘mid-priced’ dentures and not for a ‘premium’ set, here is how it would look for providing this to just 10% of the Medicare beneficiaries.
65,748,297 Medicare beneficiaries x 10% = 6,574,829 sets of dentures
6,574,829 sets of dentures x $2,000 (average of ‘mid-priced’ dentures) = $13,149,658,000.00 in additional costs for 1 year.
Offering dental coverage through Medicare, including routine visits and dentures for 10%, will require taxpayers to fund an additional $21 billion.
Last, but not least, the American Dental Association is against this proposal since it would likely result in pay cuts to dentists.
Options for Dental Coverage Under Medicare
Given Medicare’s limited dental coverage, individuals have a few options to consider for their dental care needs:
Self-Pay
Many Medicare recipients choose to pay out-of-pocket for dental services, especially those with generally healthy teeth who may only require routine cleanings.
Some may opt for dentists’ internal plans, which can offer a number of cleanings per year and discounts on other services.
Private Insurance
Dental insurance plans provided by insurance companies typically run between $25 – $75 per month depending on the level of benefits you are wanting.
Most plans provide 100% coverage for preventive services such as routine exams, cleanings, and bitewing x-rays. For items that fall under basic care, such as fillings and simple extractions, many carriers will cover these benefits at 80%.
It is important to keep in mind that some plans do have a 6-month waiting period before they will cover these services.
Most plans cover major care at 50% with a possible 12-month waiting period for these services. Major services can include crowns, bridges, dentures, implants and more. You read that correctly, while Medicare does not cover dentures, a private dental plan can.
Final Thoughts
While we can always hope that one day we will be able to find a way for Medicare beneficiaries to have complete dental coverage, it is important to act and not wait until you are possibly burdened with thousands of dollars in out-of-pocket expenses.
Now you know that Medicare will not cover dentures, so it might be time to look at other options.
Give us a call today at (800)924-4727 to discuss your options.
Sources
- Center for Medicare Advocacy: https://medicareadvocacy.org/medicare-enrollment-numbers/#:~:text=The%20Centers%20for%20Medicare%20%26%20Medicaid,are%20enrolled%20in%20Original%20Medicare.
- Dentureliving.com: https://www.dentureliving.com/en-us/advice-tips/preparing-for-dentures/costs/how-much-do-dentures-cost