Typically, plans that cover dentures generally limit coverage to one set every five years. But cost-sharing, meaning what you pay out of pocket and what insurance covers, varies widely. In 2021, plans that charged a fixed dollar copayment ranged from $0 to $500, while plans that charged coinsurance, which is a percentage of the cost, typically charged members 50 percent to 70 percent of the cost for providers within network.
Most plans set annual caps on extended dental services, averaging $1,300 in 2021, but 8 percent of plans had coverage caps of $2,000 to $5,000. This cap usually did not apply to routine and preventive dental care.
Many Medicare Advantage plans automatically include dental coverage. But some plans charge extra for additional dental benefits, for example, $40 a month for $2,000 worth of additional dental benefits, including dentures.
With such a wide range of coverage levels, it’s important to research how each plan covers dentures.
Where can I find out what Medicare Advantage covers?
You can find dental coverage information for each Medicare Advantage plan in your area using the Medicare Plan Finder. Enter your zip code. In the Design typedrop-down menu, click ◯ Medicare Advantage Plan | Apply.
You may then be asked to select your county if your zip code spans more than one. When you click Principle, you’ll first note if you get financial help, and then you’ll see an option to compare drug costs between plans. This does not include dental expenses.
From there, you can connect to a list of all the Medicare Advantage plans in your area. A green check mark is noted ✓ Dentistryin thePlan benefits list. You can narrow the list by clicking onFilter by: Plan Benefits | Dental coverage | Apply.
For general information about the plan’s denture coverage, clickDesign detailsand scroll down toAdditional Benefits. Look for itProstheticsection to find out if the plan covers dentures and other dental prosthetics, including in- and out-of-network matches. You’ll see a note if you need prior approval and are subject to program limits.
Note that the Plan Finder does not include details about these limits or what types of supplements are covered. For more information about your plan’s denture coverage, visit the plan’s website or contact the plan directly. You can find a link to the site plan in the Plan Finder and check the plan documents directly on the site.