Most full dental insurance policies include some restorative coverageusually meaning that up to 50% of the cost of dentures is covered. Regular deductibles and co-pays still apply, so the actual cost to the patient is always a substantial amount.
- Yes, dental insurance does cover dentures.
- It is considered a major procedure and is generally covered at 50% of the cost, with you paying the balance.
- Due to the annual maximum coverage limit, timing is of the essence; if you get dentures in a year when you have already had other procedures, your coverage may end up being considerably less than 50%.
What Does Dental Insurance Typically Cover?
Dental insurance has a typical annual maximum coverage cap amounting to a median of $1,500. It covers procedures strictly related to health and wellness, and it has a three-tier structure known as 100-80-50.
Preventive care—such as annual cleanings, X-rays, and sealants—is covered 100%. Basic procedures—such as fillings, extractions, and periodontal treatment for gum disease—are covered 80%. Major procedures—crowns, bridges, inlays, and dentures—are covered 50%. Depending on your plan, root canals can fall into either the basic or major category. Most plans focus on preventive and basic care, and not all procedures are covered.
Most dental insurance plans have a waiting period before they will cover a major procedure, such as dentures, and this period can be anywhere from a few months to two years.
Limitations of Dental Insurance
Most insurance companies have a waiting period for new patients, though there are some that don’t. This waiting period usually applies to nonemergency procedures, such as dentures, and typically ranges anywhere from a few to 12 months, though it can be as long as two years for some companies.
Annual coverage limits, which can be as low as $1,000 despite the median mentioned above, can result in a situation where a lost filling or cavity earlier in the year has already eaten up a large portion of that year’s dental allowance. This would likely result in dentures being covered at less than 50%, so you have to be strategic about when you plan for certain procedures.
Some employer dental insurance packages have an option for lower monthly costs but may offer little to no coverage for restorative procedures. Patients must foot the entire bill for dentures in these cases. If it is possible to wait, it may be wise to switch providers during open enrollment to an option that includes denture coverage, as the savings can easily outweigh the higher monthly cost.
Discount dental plans are not insurance. They represent a group that has negotiated discounts and fixed prices for specific dental procedures at a limited number of dental professionals in the area. Those lacking dental insurance altogether—and those with limited coverage insurance—may find savings of up to anywhere from 15% to 50% compared with regular prices. Your discount is given at the time you have your procedure, and you must pay at that time.
Because annual coverage limits generally top out at $1,500, while dentures usually start at $2,500 for an upper or lower plate, you will end up paying a large amount out of pocket when using dental insurance to get dentures. Discount dental plans have no waiting periods or annual coverage limits, so if you can find the right plan, you may do better using one of them to pay for dentures rather than using dental insurance, according to DentalPlans.com.
Before signing up for a discount dental plan, make sure that the coverage meets your needs. Also, check that the participating dentists in the area do not have prohibitively long waiting lists for new patients.