Does Dental Insurance Cover Dentures?

Most full dental insurance policies include some restorative coverage, usually 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.

What Does Dental Insurance Typically Cover?

Dental insurance has an annual maximum coverage cap which is $1,500 or higher in about 63% of PPO plans on the market. It covers procedures strictly related to health and wellness, and many dental insurance plans have three-tier structure known as 100-80-50.

• 100% covered for preventive care, such as annual cleanings, X-rays, and sealants
• 80% covered for basic procedures, such as fillings, extractions, and periodontal treatment for gum disease
• 50% covered for major procedures, such as crowns, bridges, inlays, and dentures

Most plans focus on preventive and basic care, and not all procedures are covered.

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. It typically ranges from a few to 12 months.

Annual coverage limits, which can be as low as $1,000, 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 dental insurance plans, including options offered by some employers, have lower monthly costs but may offer little to no coverage for more major items and procedures such as dentures. Patients must foot the entire bill for dentures in these cases. If it is possible to wait, it may be wise to switch providers or change plans to an option that includes denture coverage, as the savings can easily outweigh the higher monthly cost.

Discount Plans

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 10% to 60% 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.

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.

The Bottom Line

Dentures are considered a major procedure, and most dental insurance plans will cover 50% of the cost. However, there are limitations that can increase how much you are responsible for paying.

If you have already had a number of dental procedures done, you may have reached out maximum coverage for the year and be left paying for your dentures out-of-pocket. You may also be left paying out-of-pocket if you are still in your plan's waiting period. To ensure that the cost of your dentures is covered, be strategic about when you have the procedure done.