The cost of extractions and dentures with insurance depends on many factors: expense-sharing, imitations, removal reasons, and the type of false teeth.
In other words, there is no single correct answer.
First, people might have coverage through Medicare or Medicaid or a private insurance company offering various dental plans with unique features.
Second, each coverage type is more likely to cover medically necessary tooth removals than those brought about by decay or gum disease.
Third, dentures’ retail price (without insurance) can range from $500 to $7,000, depending on the material quality and other factors.
Cost With Medicare
First, we explore how much dentures with extractions cost with Medicare as your insurance. This government-run program for seniors and disabled individuals has two distinct plan designs with different benefits for dental care.
- Part B: does not pay claims for routine oral care
- Part C: may include limited benefits for dental work
Inexpensive dental implants for seniors will take you down the same dead-end street. Medicare rarely pays for oral care, and Advantage Plans have low yearly maximums.
Medicare Extractions
The unreimbursed cost of extractions with Medicare as your insurance depends on why you need the teeth pulled and the type of plan selected during open enrollment.
Part B Extractions
Medicare Part B covers tooth removal when medically necessary but does not pay claims for routine dental care. Therefore, your leftover costs could be 20% or 100%.
- 20% coinsurance: medically necessary
- In preparation for radiation treatment for jaw cancer
- Reconstruction of the jaw after an accidental injury
- 100% self-pay: dentist pulls tooth because of decay or periodontal disease
Part C Extractions
Medicare Advantage Plans (Part C) with oral care coverage pay for tooth removal for both reasons: medically necessary and due to decay or gum disease.
Therefore, your leftover costs reflect the pertinent expense-sharing feature embedded in your Advantage Plan. A 50% coinsurance is typical.
Medicare Dentures
The unreimbursed cost of dentures with Medicare as your insurance depends solely on the type of coverage you selected during open enrollment: Part B or C.
Free dentures for seniors on Medicare are possible for those dual-eligible for Medicaid, which covers false teeth with zero copayments in thirty-three states.
Part B Dentures
Seniors enrolled in the traditional Medicare Part B for medical supplies and services should expect to pay the total retail price for dentures because this plan does not cover missing teeth replacement for any reason.
Part C Dentures
Seniors enrolled in a Medicare Advantage Plan (Part C) with oral care benefits might expect to pay less than the retail price for dentures because this version lowers costs in two ways.
- In-network dentists cannot charge more than the allowed amount, a significant discount negotiated by the private insurance company.
- In-network provider: wholesale prices
- Out-of-network dentist: list price charged to uninsured
- Claim payments up to $1,500 annually take an enormous bite out of the cost of false teeth, especially if treatment spans more than one year.
Cost With Medicaid
Next, we break down how much dentures cost with extractions with Medicaid as your insurance. Medicaid is a taxpayer-funded program for low-income families with two critical elements affecting what you might spend.
- Medicaid provides health insurance for adults evenly nationwide
- Medicaid covers dental work for adults differently in each state
Free dentures for low-income adults are viable through Medicaid because the entitlement has minuscule expense-sharing elements (deductibles, copayments, etc.), so coverage is the primary variable.
Medicaid Extractions
The unreimbursed cost of extractions with Medicaid as your insurance depends on why you need the teeth removed and the oral care benefits supported in your state.
Emergency Extractions
Emergency tooth removals without dental insurance are less of a concern when medically necessary. Medicaid might pay for the service regardless of where you live under its health insurance component.
- In preparation for radiation treatment for jaw cancer
- Reconstruction of the jaw after an accidental injury
Routine Extractions
In thirty-seven states, Medicaid pays for routine tooth removal (caused by decay or periodontal disease), while the remaining thirteen cover emergency care only.
Therefore, your leftover costs could be zero or the total retail price if you live in one of the thirteen states that cover emergency dental care only.
States Supporting Emergency Care Only 2022
| Alabama | Arizona | Georgia |
| Hawaii | Idaho | Kansas |
| Maine | Maryland | Mississippi |
| Missouri | New Hampshire | Oklahoma |
| Tennessee | Texas | Utah |
| West Virginia |
Medicaid Dentures
The unreimbursed cost of dentures with Medicaid as your insurance depends on oral care benefits supported in your state and whether you selected the least expensive treatment alternative.
Medicaid pays for dentures in thirty-three states, meaning your costs will be close to zero if you live in a designated region. However, those residing in the seventeen other states must pay the retail price.
Medicaid pays for the least expensive treatment alternative, meaning you might have to settle for low-quality false teeth with a high risk of cracking, shrinking, slipping, or appearing unnatural.
Cost With Dental Insurance
Finally, we explore how much dentures cost with extractions with dental insurance. In this case, we utilize the author’s plan to illustrate how expense-sharing and other limitations affect what you might spend out-of-pocket.
- Annual benefit maximum: $2,500
- Coinsurance
- Routine care: 80%
- Prosthetic benefits: 50%
Dental Extractions
The procedure’s complexity and your plan’s coinsurance affect the unreimbursed cost of extractions with dental insurance.
Bone-Impacted
Wisdom teeth removal cost with insurance is nearly zero when bone-impacted because two policies may honor claims. The surgical extraction of bony-impacted molars, premolars, bicuspids, and canines is medically necessary.
- Primary: Medical insurance pays after meeting a deductible
- Secondary: Dental insurance fills in leftover expenses
Simple Extractions
The coinsurance drives most of the leftover cost of simple, non-surgical tooth removal with dental insurance. In this case, the plan pays 80% of the allowed amount, leaving the patient to fund the remaining 20%.
| Retail Price | Allowed Amount | Plan Pays | Patient Owes | |
|---|---|---|---|---|
| 1 Tooth | $350 | $200 | $160 | $40 |
| 5 Teeth | $1,750 | $1,000 | $800 | $200 |
| 10 Teeth | $3,500 | $2,000 | $1,600 | $400 |
Dental Dentures
The unreimbursed cost of dentures with dental insurance can vary widely due to exclusions, the interaction of several expense-sharing features, and the timing of treatment.
Implant Dentures
The leftover cost of implant dentures with dental insurance mirrors the retail price because the author’s plan does not include this benefit.
Dental insurance that covers implants is the exception, not the rule. Therefore, do not expect to get in-network discounts via the allowed amount or any claims support from your plan.
Removable Dentures
The leftover cost of removable dentures with dental insurance could be more affordable when you split treatment over time because the author’s plan has a $2,500 annual maximum, which might limit benefits.
| Upper Jaw | Lower Jaw | Total | |
|---|---|---|---|
| Retail Price | $3,500 | $3,000 | $6,500 |
| Allowed Amount | $2,500 | $2,200 | $4,700 |
| Coinsurance: 50% | $1,250 | $1,100 | $2,350 |
In this illustration, the annual maximum does not limit claim payments. However, you can easily reach the ceiling with previous tooth removals and other services such as exams, cleanings, x-rays, etc.
Here is what to do when dental insurance is maxed out: spread treatment over time. For instance, address the upper jaw in year one and the lower in year two instead of completing treatment simultaneously.
