How To Get Dentures On Medicare?

Vincent Thrasher

Founder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior...Read more

As we age, our teeth may start to deteriorate, making it difficult to eat and speak properly. This is where dentures come in, providing a solution to missing or damaged teeth. However, many seniors wonder if they can afford dentures on Medicare. In this article, we will explore how to get dentures on Medicare, the costs involved, and what to expect during the process.

Dentures are an important investment for your oral health and overall well-being. If you’re a Medicare recipient, you may be wondering if your plan covers the cost of dentures. Fortunately, there are options available to help you get the dentures you need without breaking the bank. So, let’s dive in and explore how you can get dentures on Medicare.

How to Get Dentures on Medicare?

Are you a Medicare beneficiary in need of dentures? Medicare coverage for dental services is limited, but you may be eligible for coverage of some or all of the cost of dentures under certain circumstances. In this article, we’ll explore how to get dentures on Medicare.

1. Understanding Dental Coverage Under Medicare

Under Original Medicare (Part A and Part B), dental services are not typically covered. However, there are two situations in which Medicare may cover the cost of dentures:

• If you need dental services as a result of an injury or accident, Medicare Part A may cover the cost of some dental services, including dentures.


• If you have a medical condition that requires oral surgery, Medicare Part A may cover the cost of some dental services, including dentures.

If you have a Medicare Advantage (Part C) plan, your plan may offer additional dental coverage. Check with your plan to determine if it covers dentures.

2. Meeting Medicare’s Criteria for Coverage

If you meet the criteria for coverage under Original Medicare, you may be eligible for coverage of some or all of the cost of dentures. However, there are some things you should keep in mind:

• Medicare will only cover the cost of dentures that are deemed medically necessary. This means that the dentures must be required to treat a medical condition or injury, not simply for cosmetic reasons.


• Medicare will only cover the cost of basic dentures. If you want dentures that are more expensive or have extra features, you will likely need to pay for those costs out of pocket.

3. Finding a Dentist Who Accepts Medicare

Once you have determined that you meet Medicare’s criteria for coverage, you will need to find a dentist who accepts Medicare. Not all dentists accept Medicare, so it’s important to do your research.

• You can use Medicare’s “Physician Compare” tool to find dentists in your area who accept Medicare.


• You can also contact your state’s dental association for a list of dentists who accept Medicare.

4. Understanding the Costs of Dentures

Even if you meet Medicare’s criteria for coverage, you will likely still have to pay some out-of-pocket costs for your dentures. Here are some things to keep in mind:

• Medicare will typically cover 80% of the cost of dentures, leaving you responsible for the remaining 20%.


• If you have a Medicare Advantage plan, your plan may cover a larger portion of the cost of dentures.


• If you have a Medigap policy, it may help cover some or all of the remaining 20% of the cost of dentures.

5. Applying for Coverage

If you believe you meet Medicare’s criteria for coverage of dentures, you will need to submit a claim to Medicare. Here’s how to do it:

• Ask your dentist to submit a claim to Medicare on your behalf.


• If your dentist does not submit a claim, you can submit one yourself by completing a “Patient Request for Medical Payment” form.

6. Alternative Options for Dental Coverage

If you do not meet Medicare’s criteria for coverage of dentures, there are other options you can explore:

• You can purchase a dental insurance plan that covers dentures.


• You can explore discount dental plans that offer reduced rates on dental services, including dentures.


• You can look into charitable organizations that provide free or low-cost dental care to individuals in need.

7. Benefits of Dentures

Getting dentures can offer a number of benefits, including:

• Improved ability to eat and speak


• Restored confidence and self-esteem


• Prevention of further oral health issues

8. Dentures vs. Other Tooth Replacement Options

If you are considering dentures, it’s important to understand how they compare to other tooth replacement options, such as dental implants and bridges. Here are some things to keep in mind:

• Dentures are typically less expensive than dental implants and bridges.


• Dentures are removable, while dental implants and bridges are not.


• Dentures may be less comfortable and require more maintenance than dental implants and bridges.

9. Caring for Your Dentures

Once you have dentures, it’s important to take good care of them to keep them in good condition and prevent oral health issues. Here are some tips:

• Clean your dentures daily with a soft-bristled brush and denture cleaner.


• Remove your dentures at night to allow your gums to rest.


• Visit your dentist regularly for adjustments and maintenance.

10. Final Thoughts

Getting dentures on Medicare may be possible if you meet Medicare’s criteria for coverage. Be sure to do your research and understand the costs and benefits of dentures before making a decision. If you have questions or need assistance, don’t hesitate to reach out to Medicare or a dental professional.

Frequently Asked Questions

Here are some common questions about getting dentures on Medicare:

What is Medicare?

Medicare is a federal health insurance program that provides coverage for people who are 65 or older, people with certain disabilities, and people with End-Stage Renal Disease (ESRD).

It is divided into several parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

Does Medicare cover dentures?

Yes, Medicare does cover dentures in some cases. However, the coverage is limited and may not cover all of the costs associated with getting dentures.

For example, Medicare Part A (hospital insurance) may cover the cost of dentures if they are needed after a hospital stay. Medicare Part B (medical insurance) may cover some of the cost of dentures if they are deemed medically necessary and are prescribed by a dentist or oral surgeon.

How much does Medicare pay for dentures?

The amount that Medicare pays for dentures varies depending on the type of coverage you have and the specific circumstances of your case. In general, Medicare will only pay a portion of the cost of dentures.

It is important to note that if you have a Medicare Advantage plan, your coverage and costs may be different than those under Original Medicare.

What is the process for getting dentures on Medicare?

The process for getting dentures on Medicare typically involves several steps. First, you will need to find a dentist or oral surgeon who accepts Medicare. Then, you will need to have an exam to determine if dentures are necessary and what type of dentures will be most appropriate for you.

Once the dentures have been prescribed, you will need to work with the dentist or oral surgeon to get them fitted and adjusted. Medicare will only cover the cost of dentures from providers who accept Medicare assignment, so it is important to confirm this before beginning the process.

Can I get dentures if I have a Medicare Advantage plan?

Yes, you can still get dentures if you have a Medicare Advantage plan. However, the coverage and costs may be different than those under Original Medicare.

It is important to check with your plan provider to determine what is covered and what your out-of-pocket costs may be before beginning the process of getting dentures.

In conclusion, getting dentures on Medicare is possible, but there are certain requirements and limitations that you should be aware of. It is important to understand the coverage and costs associated with this process before making any decisions.

Medicare Part A and Part B do not cover routine dental care, including dentures. However, Medicare Advantage plans may offer additional benefits that cover some or all of the costs of dentures. It is important to research and compare different plans to find the one that best fits your needs.

If you are in need of dentures and are eligible for Medicare, don’t let the cost discourage you. With careful planning and research, you can find a plan that will help cover the costs and get you the dental care you need to maintain your quality of life. Remember, taking care of your dental health is an investment in your overall well-being.

Vincent ThrasherFounder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior insurance, encompassing Medicare, Medigap, long-term care insurance, life insurance, and dental, vision, and hearing insurance. Vincent's unwavering passion for guiding seniors through the intricate insurance landscape and crafting customized solutions to address their individual needs has earned Over65InsuranceOptions an esteemed reputation as a dependable ally for seniors nationwide.

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