Medicaid coverage varies from state to state, and typically depends on whether the service is considered medically necessary.
Dentures are much more common than many people realize. As we age, the possibility of needing dentures gets higher and higher. People lose calcium and other minerals that decrease bone density as they get older, which can lead to issues with teeth.
Though many link dentures and the 65+ crowd in their mind, it is not uncommon for younger adults, or even children, to need some type of dental prosthetic. This leaves many wondering if Medicaid will cover dentures. As with most Medicaid benefits, the answer depends on your state and specific needs.
When does Medicaid cover dentures?
Whether Medicaid will cover dentures depends largely on where you live. Medicaid is a federal program, with a minimum level of coverage required to be provided in each state. However, individual states can decide to offer additional coverage if they wish.
Since dental coverage is not federally mandated, and so many states refuse federal dollars to expand their Medicaid programs, many states offer zero dental benefits to their adult Medicaid enrollees.
Even if your state does include dental coverage, it still may not include dentures as part of it unless they are deemed medically necessary. In this case, medically necessary would mean not having dentures would interfere with normal oral activity such as chewing, swallowing, or speaking.
The best way to see if your Medicaid program covers dentures is to check with your specific state.
Other ways to pay for dentures
Outside of Medicaid coverage, a dental insurance plan should be able to help. Costs vary based on the plan and coverage options you choose, but as long as you pick one that includes dentures or tooth implants you will be covered. Going to a dental school in your area is another great way to get affordable dental care and/or dentures. You might spend more time at your appointment, but you'll also spend significantly less.
What if you also qualify for Medicare?
A common question is whether Medicare covers dentures, with the quick answer being that Medicare does not include any dental coverage. However, a Medicare Advantage plan with dental may cover at least part of your dentures. It depends on the specific benefits offered by your Advantage plan.
If you qualify for both Medicare and Medicaid, you may be eligible for additional benefits. To learn more, call us toll-free at 888-992-0738 and one of our licensed ClearMatch Medicare agents will answer your questions to help you better understand your Medicare options.
What are dentures made from?
There are multiple materials dentures can be made from, but the most common include:
Made up of pink fake gums and resin-colored teeth, acrylic dentures are light and easy to adjust and tend to cost less than materials like porcelain. However, they also tend to wear down quicker and may need to be replaced more often.
Harder than acrylic, porcelain dentures are more durable and handle the daily wear and tear on your teeth better than other dentures. They also come with the benefit of looking more like natural teeth.
Porcelain dentures are more expensive than acrylic, and cost more to fix or replace if damaged.
In this style of dentures, either the clasp or palate layer is made from metal, typically cobalt chrome. While they are durable and long-lasting, the metal is often easily noticed, so they might not be the best choice for someone looking to conceal their dentures.
Types of dentures
Dentures are split into two main types: full (also called "complete") dentures and partial dentures.
Full dentures replace the entire set of teeth on your upper or lower jaw. Partial dentures replace only part of the set of teeth on your upper or lower jaw. From there, they break down into more specific categories.
Also known as immediate dentures, temporary dentures are fitted right after your teeth are removed. They are meant to help you maintain normal oral function until your permanent dentures are ready or implanted.
Dentists often recommend them to help you ease into wearing dentures. They reduce the pressure on your remaining natural teeth, so it is easier for your gums to heal, reducing the likelihood of issues once you receive your permanent dentures.
Even with temporary dentures, your dentist will measure your teeth and make any necessary models beforehand to ensure the best possible fit.
Removable dentures vs fixed dentures
Both removable and fixed dentures can be either full or partial sets.
Removable dentures are what most people think of when they picture dentures: a set of teeth that can be taken out, often left in a glass of water or other cleaning solution overnight to keep them from drying out. They are easy to clean at home and most people adapt fairly quickly, getting a new smile at a lower cost than fixed dentures.
However, removable dentures need to be removed and cleaned daily, otherwise you risk bacteria build-up. They can also slip out if you are not using any type of dental adhesive and can lead to bone loss if there is nothing affixed to the jaw.
Fixed dentures are often referred to simply as dental implants, as they are surgically attached to the bone.
These implants are made up of three parts: a piece that screws into the bone, an abutment that sits in the screw, and a crown that attaches to the abutment. The crown can be either fixed in place, or a snap-on piece that can be removed.
Fixed dentures look more natural than removable dentures and also hold your jaw and bone structure in place. But they also require a surgical process that removable dentures don't, increasing the cost and adding to the amount of time it takes to heal.
A type of partial denture, flexible dentures are usually made from some type of thermoplastic, such as nylon, instead of the more traditional acrylic or porcelain. They tend to be more comfortable than other partial dentures and have no metal that may show through.
Flexible dentures do not always fit as well as other types, however, and as they move can lead to irritation and a buildup of bacteria.
The most cost-effective type of denture, economy dentures are also called generic dentures. They typically look more fake compared to other types of dentures and do not fit as comfortably or securely in the mouth, requiring a dental adhesive to stay in place.
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