Does Dental Insurance Cover Dentures?

Replacing lost teeth might mean you opt for a denture, an implant, or a bridge, depending on what your dentist recommends. But that's just one side of the story. Dentures are pricey — people are often confused about whether the treatment comes under their insurance policies. While some dental insurance plans can cover up to 50% of your new dentures, other factors decide the final cost of full dentures. In this article, we explore whether dental insurance covers dentures, the factors that determine the extent of coverage, and ways to get the most out of your plan.

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Understanding dentures: types and costs

Dentures are artificial and customized teeth and gum replacements that fill the areas where you have lost teeth. They mimic the natural teeth in color, texture, and function. The materials used for dentures can vary from resin acrylics to porcelain to metal frames. Here is a list of the major kinds of dentures.

• Full dentures, also known as full mouth dentures or complete dentures. They are for edentulous people who have lost all their teeth. These can be removable or fixed and come customized for both arches.
• Partial dentures are for people who have lost some of their teeth. These can be fixed or removable. They can come with metal frameworks and embedded wires to enhance fit and stability.
• Implant-supported dentures are a costly and better alternative to removable dentures. These dentures require an optimum amount of healthy bone structure — and are a great option for people looking for a longer-lasting solution.

Dentures cost

The cost of your dentures can vary. It depends on the materials used while fabricating the dentures, the area inside your mouth that needs to be covered, lab costs, and the complexity of the case. Dentists’ fees might also vary on their clinical experience and expertise.

The average cost of dentures can be anywhere between $1,000 to $5,000. The rates can go beyond if you need additional steps like extraction, bone grafts, and gum contouring. If you opt for an implant-supported one, the costs might rise significantly.

Dental insurance and dentures: what's covered?

Traditionally, dental insurances cover dentures under major restorative dental services.

Most dental insurance plans will cover only half of the total cost of dentures. The amount paid by your insurance company also depends on whether you are within the annual maximum limit provided by them (the total amount the plan will pay for your dental care in a year). So, if you have already taken previous dental services in a year, your plan might require you to wait until next year to get your dentures covered.

Factors affecting denture insurance coverage

More than 120 million people in the U.S. are missing at least one tooth, and 90% of them opt for dentures. With numbers on the rise, you should be aware of the factors that can influence your coverage for dentures. Here are three key ones that you should keep in mind if you are planning a new set of dentures.

• Medical necessity. The dentist will most likely claim your procedure as a medical necessity, meaning you need the dentures to eat, talk, and function in a healthy way. This makes claiming coverage easier, rather than for a purely cosmetic procedure.
• Type of insurance plan. Discuss factors like waiting periods, annual limits, and time-lapse between re-treatments (some plans will provide coverage only once in 5–7 years) before you plan your dentures.
• In vs. out-of-network dentists. In case you choose an out-of-network dentist, the coverage might be less (or nil), depending on your policy.

Maximizing your dental insurance benefits

There are ways to maximize insurance coverage for dentures, despite the many limiting factors. Here is a quick checklist that can help you.

Understanding your dental plan

It's not enough to get dental insurance done. Rather, try to be aware of the ins and outs of your policy. Read documents before you sign up. If you don't get the phrases and clauses, ask your policy service provider to talk you through it.

Timing denture procedures to optimize coverage

Make sure you time your new dentures in such a way that you get the best out of the policy. Plan your dental services to accommodate waiting periods and annual maximum limits. Choose an in-network dentist to get the most of the coverage.

Exploring alternative payment options or dental discount plans

Some dentists can offer discounted rates — and alternative payment options — when you take a specific policy plan. The payment options can be monthly installments or part payments. Make sure to talk to your dentist regarding this.

Explore affordable dental care providers

Dental schools can offer affordable dentures as a part of their curriculum and training programs for dental students. Some non-government organizations and charity hospitals might also help you get a new set of dentures at subsidized rates.

Check your local community resources

The Affordable Care Act Medicaid expansion has led to improved dental insurance access — and dental care services for edentulous patients — in states that provide the benefits. Make sure you explore whether you are eligible for the same.

Dentures are a significant investment, and dental insurance coverage can vary. You can try and make the best out of your insurance plan only if you are aware of the details.

Stay informed. Ask questions and talk to your service provider. Explore treatment options with your dentist. Your insurance structure can make a huge difference in how you invest in your dentures and your oral health.