How Much Dentures Cost with Insurance | Medicare & Medicaid

The cost of dentures without insurance can range from $500 to $8,000 depending on the quality of materials used, arches fabricated and fitted, and the number of artificial teeth you need.

However, asking how much dentures cost with insurance might be a better question because patients often have several money-saving opportunities left to discover and explore in detail.

For instance, senior citizens on Medicare often pay the retail price because their insurance will not honor claims. However, they could still buy a dental plan, or the healthcare component could pay for oral care that is medically necessary.   

Meanwhile, Medicaid sometimes works as both health and dental insurance.

How Much Dentures Cost with Medicare

Estimating how much dentures cost with Medicare provides a baseline for the remainder of this article. Seniors pay the same full retail price as other patients without insurance.

Medicare rules explicitly exclude “services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth.”

Implant-Supported

The cost of implant-supported dentures with Medicare drives senior citizens to spend the highest because these permanent replacement teeth represent the most expensive treatment choice without insurance.

Dental implants for seniors on Medicare feature prices ranging from $3,500 for a single tooth to $60,000 for a full-mouth replacement, including the upper and lower jaw. The crowns screw in or snap on the abutment as the last step in the procedure.

Partial vs. Full

The cost of dentures with Medicare will also vary depending on whether the senior needs to pay for a partial or complete set of choppers without insurance. Adults have thirty-two teeth.

A single replacement tooth will be more affordable, but a whole set is not 32 times more expensive. The differences are only minor if you ignore the cost to extract any remaining teeth.

  • Full arches require the dentist to take impressions, and the lab fabricates a single appliance designed to fit over the gums
    • Low end: $700 per arch
    • High end: $2,000 per arch
  • Partials require accurate impressions, bite assessments, and specialized ways to anchor the appliance or bridge to surrounding teeth
    • Low end: $700 per arch
    • High end: $1,700 per arch

Upper vs. Lower

The cost of dentures with Medicare will not change much for seniors paying for complete sets for the upper (Maxilla) or lower (Mandible) jaw without insurance.

However, upper bridges have two design choices that could affect spending.

  • Conventional upper arches cover the patient’s palate and utilize saliva in the mouth to create suction for stability
  • Horseshoe upper arches do not have a palate, allowing the patient to taste and feel food while eating, but require the use of adhesives to keep the appliance in place

Permanent vs. Temporary

The cost of dentures with Medicare will also be different for permanent versus temporary treatments because of the extra steps the dentist must perform to install immediate dental plates.

Immediate dentures are temporary appliances that the dentist puts in while the lab fabricates the permanent set of new choppers. Therefore, expect to pay a premium for the short-term treatment.

Brands & Materials

Finally, a senior’s choice of brand or material has the most profound impact on the cost of dentures with Medicare. You will find a broad spectrum of price points for appliances offering different benefits: slip resistance, natural look, tooth shades, etc.

For instance, consider a per-arch price listing for partials. [1]

  • Acrylic: $695
  • Hybrid Metal: $1,695
  • Cast Metal: $1,295
  • Titanium: $1,695
  • Acetal Resin: $1,695
  • Valplast Flexible: $1,295

How Much Dentures Cost with Dental Insurance

Approximating how much dentures cost with dental insurance can help you decide whether buying a new plan will prove worthwhile. However, four standard features could profoundly affect your total net spending: monthly premiums and unreimbursed expenses.

Waiting Periods

The waiting period and a related exclusion embedded in most plans could sharply increase your cost of dentures with dental insurance. The issuing companies include these features to prevent people from running up claims far above premiums paid.

  • The waiting period is the time after the effective date during which the plan will not honor claims for specified services
  • Missing tooth exclusions means the plan will not cover replacement services for any pre-existing extractions

Dental insurance without waiting periods will include missing tooth exclusions and feature graded benefits that pay less in the early years. Any honest cost-to-benefit analysis solves to break even at best – unless you consider network discounts (allowed amount).

Allowed Amount

The allowed amount and network participation are two co-dependent variables that go into the denture cost with the dental insurance equation. Your choice of words (accept versus participate) when interviewing dentists can make an enormous difference.

  • In-network dentists accept the allowed amount as full payment. They participate in your plan and agree to discounted rates in exchange for patient volume
  • Out-of-network dentists can charge above the allowed amount. They do not participate in your plan even though they happily accept claims checks issued by your insurance

The allowed amount is a pre-negotiated discount price. Insurance companies have vast member rolls, which provide significant bargaining power. Subtract an average 30% – 50% price reduction off the retail rate.

Annual Maximum

Another significant variable that goes into the denture cost with the dental insurance equation is the annual maximum. This feature defines the yearly benefit limit the plan will pay in claims per person.

For example, consider a plan with a $1,500 maximum annual benefit. The patient chooses high-end, complete, upper and lower bridges and an in-network dentist.

  • Retail Price: $4,000
  • Allowed Amount: $3,000
  • Coinsurance: 50% or $1,5000

In this example, the patient does not feel the annual maximum. However, any other work performed earlier or later in the year, such as extractions, pushes the individual over the limit, increasing unreimbursed expenses.

Cosmetic Appliances

The cost of cosmetic dentures with dental insurance is another critical point for patients to consider. Cosmetic procedures improve appearance rather than restore function, and most plans will not approve claims for these services.

Dental insurance covering cosmetic procedures contradicts terms because most patients plan these services for years. Insurance address unforeseen hazards. Therefore, do not expect much savings if you find a plan offering this benefit.

Most patients pay for facelift, fountain of youth, gold, zirconia, and other dentures designed to improve appearance as though they have no insurance.

How Much Dentures Cost with Health Insurance

Guessing how much dentures cost with health insurance provides an opportunity to illustrate two key points that can help patients with their budgeting.

  1. Dentists rarely install these appliances in isolation and frequently address other oral care needs in preparation for artificial teeth
  2. Health insurance sometimes pays for preliminary dental work when medically necessary or an integral part of other covered services

Tooth Extractions

For example, your cost of dentures with health insurance could be considerably lower when your plan covers tooth extractions. There are several instances when this preliminary oral care procedure falls into the medically necessary category.

Jaw Surgery

In other instances, your cost of dentures with health insurance could be much lower when an oral surgeon performs jaw surgery to prepare your mandible or maxilla to support the dental plate.

Many orthognathic surgeries fall into the medically necessary category, which leads to honored claims.

  • Open reduction of a fractured jaw
  • Removal of cysts and cancerous tumors
  • Correction of significant congenital deformities

How Much Dentures Cost with Medicaid

Finally, we can combine the points noted above to address how much dentures cost with Medicaid. This publically-funded program for low-income families works as dual coverage.

As you will shortly see, the cost of dentures with Medicaid could be close to zero for individuals living in a state that supports restorative dental benefits and choose the least costly treatment option. Meanwhile, others might pay the total price.

State Policies

The individual state-by-state policies regarding dental care significantly impact the cost of dentures with Medicaid because some low-income patients will have coverage while others must self-pay.

Therefore, the state where you live determines the Medicaid benefits you might receive for preparatory work and the installation of artificial teeth.

Dental Procedure CategoryNumber of States Supporting

Emergency Treatment

50

Preventive Services

41

Restorative Care

26

Periodontal Work

21

Dentures

24

Least-Costly Alternative

The least-costly alternative rule plays an enormous role in the cost of dentures with Medicaid – for low-income patients that live in states the cover this specific dental procedure.

As noted above, twenty-four states explicitly declare that their Medicaid plans will cover dentures. However, the least-costly alternative rule means that you cannot choose any brand or material and expect full coverage.

The least-costly alternative rule means that Medicaid might pay for the cheaper acrylic models instead of, the pricier titanium, Valplast, or hybrid metal options. Therefore, expect to pay the majority out-of-pocket for premium appliances.


Article Citations:

[1] Euro Dental Partial Prices