Are Dentures Covered By Medicare?

Dentures are an important piece of equipment for those who have lost teeth. When you start to lose your natural teeth, dentures can help fill the void and keep your mouth healthy. Since artificial teeth come at a high price, there are many questions about the payment options available for this dental treatment. 

Medicare coverage for dentures is a topic that many people are interested in. This post will go over the basics, and then we’ll talk about what you need to do if you want more information. We’ll also discuss some of the misconceptions about Medicare coverage for false teeth and offer tips on how to find a cheaper alternative if your budget doesn’t allow it. 

What is Medicare?

Medicare is an Australian national health insurance program to provide healthcare services for Australians at low or no cost. Medicare has a wide range of benefits like medical services for hospitals, specialist treatment, tests and diagnostics. It’s designed to make it easier for people on low income to access necessary healthcare services and provide financial relief for those who need it most. 

Medicare offers several service benefits for eligible patients, and it can provide a lot of relief for patients. For example, Medicare pays up to 85% of the fees listed in their Benefits Schedule or 75% when a private hospital treats you with services covered under your plan. You can get all these treatments without paying anything out-of-pocket if providers accept them as full payment and bill Medicare directly (bulk billing).

What Dental Services Medicare Cover?

Given the cost of dental care in Australia, most people require some financial assistance to cover their expenses. For those who meet the basic criteria for Medicare benefits, this can be a lifesaver that allows them access to essential services which might otherwise out-of-reach financially or impossible due to time constraints.

The Australian Government only covers some dental costs, most of which are paid for by the patient. It is different from how it functions with other health services. Still, there are a few essential treatments available to those who need them.

  • Tooth extraction – While Medicare will cover the cost of a tooth extraction, it won’t help you with your permanent dentures after the dental procedure. Similarly, suppose you have been in an accident and need to extract teeth as part of the oral surgery for facial injuries. In that case, Medicare should be covering that, but again, they don’t pay anything else once those teeth are removed.
  • Examination, diagnostic, preventive services, and restorative dental care are typically covered (depending on the state/territory) with partial or full coverage of costs.
  • Emergency Treatment Services: Dental trauma or facial injury, swelling of the face or neck, swelling in the mouth, bleeding gums that won’t stop, or problem in opening the jaw or swallowing.
  • Treatment for children (Child Dental Benefits Schedule): This pays out $1,000 across two consecutive calendar years on the condition that children must be between 2-17 years old to receive necessary basic dental care such as oral exams, x-rays, cleanings, dental filling, fissure sealing, extraction, and root canal therapy. However, Medicare does not have coverage for dental procedures that are orthodontic or cosmetic, as well as in-hospital dental treatment.

**To find out if your child is eligible for Medicare dental coverage, visit the Department of Human Services website.

  • Adult dental services: Adults with a Health Care Card, Pensioner Concession Card or Commonwealth Seniors Health Card from the Department of Human Services (DHS) or Department of Veterans Affairs (DVA) can be covered, but the eligibility and treatments vary depending on which state you reside in.

Medicare does not cover the following: 

  • Cosmetic enhancements such as teeth whitening, braces, or veneers
  • Conventional Dentures 
  • Dental implants / Implant dentures / Implant-supported dentures

As you can see from the preceding example, some situations in which Medicare will only cover one part of your dental care. For instance, if you need to have the tooth extractions for an injury repair surgery, it won’t provide coverage for any other work that may be necessary long term like complete dentures / traditional dentures or rehabilitation treatment.

Does Medicare Cover the Cost of Dentures?

The thing that a lot of Australians don’t realize about Medicare is the level of coverage. I’m sure you’re all aware that Medicare coverage can be a little tricky to understand. There are certain things, like removable dentures and dental devices which aren’t covered by the program. However, if you have a private dental insurance plan, it could be possible to get this benefit with their plans.

How Much Do Dentures Cost?

When it comes down to your oral health, you want the best care possible. With several kinds of dentures having all sorts of customization options at various price ranges, there’s never been an easier way for patients like yourself to find what works best. Your dentist will help you obtain the perfect one for your unique needs, whether it’s aesthetic-wise or clinical. The cost of these customized dental appliances varies from person to person because they are tailored to meet individual specifications. A prosthetist assesses what kind of denture best suits a patient before providing an estimate on materials and configurations that match up with them.

These replacement teeth come at a hefty price. Depending on the quality of materials they’re made from and their complexity, it ranges from $2,000-$4,000 for complete coverage; $700-$1,700 for partial coverages.

Here’s the average price of dentures in Australia in 2021:

Item NumberType Of DenturesAverage Cost **From**
711 / 712Full Upper or Lower$1,100
719Full Upper or Lower Set$2,100
721 / 722Partial Acrylic Denture$700
721 / 722Flexible Denture$1,100
743 / 744Denture Relines$300
The Dentures Cost Guide provides a range of prices depending on the complexity of your treatment, materials used, and the number of teeth to be extracted. For a comprehensive quote, please contact our clinic for an appointment or more information!

The Dentures Cost Guide provides a range of prices depending on the complexity of your treatment, materials used, and the number of teeth to be extracted. For a comprehensive quote, please contact our clinic for an appointment or more information!

Want to Learn More? Read Our Detailed Guide Here: Everything You Need to Know About Cost of Dentures

Does a Private Health Insurance Company Cover the Cost of Dentures?

Some private insurance companies cover these fees to make them more affordable for those who can’t afford the total cost. It’s worth contacting your provider and asking about their coverage policies in detail. Hence, you’re aware of what they will pay out-of-pocket on your behalf.

Final thoughts

Getting dentures can be expensive, and many people end up with a large dental bill if they don’t have enough coverage for this procedure. Unfortunately, Medicare doesn’t cover the cost, so your other option is through private dental health insurance. However, they may cover the expenses depending on your insurance policy. 

However, if you are still struggling to find a way to afford dental care, contact Peel Dental Studio today at 08 9535 4900 and ask about our affordable payment options so we can work with your budget to make sure you get the proper treatment for your needs. We want everyone who needs it to be able to get the best possible dental care. Our professional team will walk you through all of the different types of denture treatments available so that we can find what’s best for you and create an individualized plan just as unique as you are!

Dr. Ross Bailey

https://peeldentalstudio.com.au

Dr Bailey currently serves on the Australian Dental Association as immediate Past President, and before this has held office as President, Treasurer and Country Councillor. He is on the Australian Dental Association Federal Council and has always been keen to give back to the profession that has been his life. He has tutored young dentists at the Oral Health Centre in Perth, which he has held for over 20 years.

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