Are Dentures Covered by Insurance?

Medical insurance is one of the most important things to have in the United States today.

We would be forced to pay through the nose for basic medical care without it. Many of us would not be able to keep afloat financially because of the expense.

Since it is so important to our continued well-being, when you are looking for new insurance to sign up to or even at your current insurance, you want to know what it will and won’t cover.

Most insurances will cover the big things: broken bones, check-ups, and prosthetics. But how about dentures? Are they covered by medical insurance?

It seems such a small thing, but as you get older it is definitely something you want to check, so today we are going to look at dentures, whether insurance will cover them, and what you could do without insurance.

What are Dentures?

In essence, dentures are tooth prosthetics. They are prosthetic devices that substitute missing teeth.

Dentures are held in place and supported by the surrounding soft and hard tissues with the mouth itself.

There are two main types of dentures: Full and Partial. Full dentures are for people who have no teeth on one or both arches of the mouth – the lower and upper parts of the gum line.

These dentures are held in place by suction due to the absence of a hard surface to attach to, which can make them a little painful for those using them for the first time.

Partial dentures are for those who still have some teeth that are healthy and within the mouth.

These dentures use the teeth within the mouth as an anchor to attach themselves to, which makes them easier to hold in place and less painful than full dentures.

The reason that dentures are necessary and popular – especially among older generations – is that as we get older, our teeth get more fragile and begin to degrade quicker as a result.

People still need to chew their food before swallowing, so having removable teeth to replace the lost ones is a good way to manage this.

Since the mouth and tooth line is unique to each individual, each set of dentures needs to be crafted with care and consideration, which takes time and money to do.

As such, it can be quite costly to get a set of dentures, depending on the dentist.

Will Dental Insurance Cover my Dentures?

As with most medical or dental insurances in the United States, the answer is: ‘yes, but…’.

Most insurance plans will cover part of the cost of dentures. Normally, this means up to 50% of the cost is covered, with regular deductibles and copays still applying.

This means that the patient who wants the dentures will still have to pay a significant amount of money to get the dentures.

So, the reason that you will still have to pay a high amount, despite having insurance, is to do with the coverage cap and the three-tier structure that dental insurance works under: 100-80-50.

The annual coverage cap is normally around $1500 with the cap being strictly about health and wellness, not cosmetic procedures.

This cap means that insurance companies have introduced a three-tier system about how much they will spend for their policyholder before cutting them off.

The 100 group are the medical procedures that insurance will cover 100% of the price of the treatment. These are normally Preventative care treatments, like check-ups and sealants.

The 80 group are the medical procedures that insurance will cover 80% of the price of the treatment. These are Basic procedures, like fillings and extractions.

Finally, there is the 50 group, which are medical procedures that insurance will cover 50% of the price of the treatment. These are Major procedures, like crowns, bridges, and – you guessed it – dentures.

So, unfortunately, even with insurance, you will likely have to pay at least 50% of the cost of your dentures. While most dental insurances have payment plans to help with this, it still is a costly endeavor.

Not only that, but most dental plans have a waiting period before they will cover major procedures. This waiting period can be from a few months to up to 2 years, which is not ideal.

How Much are Dentures without Insurance?

A lot is the answer. A massive amount. For custom fitted dentures that cover either a full upper or lower part of your mouth, then you are looking at between $1700 and $3500 dollars and that is just the average.

If you have no teeth left and are looking for both upper and lower dentures, then double that.

It costs less if you only need partial dentures, but not much less, and it all depends on whether you can cut a good deal with your dentist.

Basic sized dentures that are not custom fitted to your mouth are much cheaper and can be easily gotten from clinics.

They cost around $300 to $600 per denture, but they are not as comfortable, and they are of lower quality.

The other thing to consider is that dentures are not going to be your only expense, if you need them.

You will also need X-rays, examinations, tooth extractions, realignments, measurements, molds, and so on, which can rake up costs at a couple of hundred per procedure.

In total, you could be looking at between $4000 and $6000 spent just on dentures, if you don’t have medical insurance.  

Conclusion

Dentures can be a major part of your private health care plan and a major part of your general health and wellbeing, but they can also have a major impact on your bank account.

Make sure that you have dental insurance to cover the initial costs of your new teeth, and that you shop around for a company that offers you a good discount plan for your dentures.

Frequently Asked Questions