While a genuine smile is priceless, the cost of dentures can be significant. Knowing how your dental coverage works can help you for getting dentures.
Dentures are removable oral devices that replace missing teeth. They're typically made from materials like acrylic, resin, nylon, metal, and porcelain. Dentures are frequently considered a major dental service, and after you pay your plan's deductible, the insurer will typically pay half of the bill.
If the cost of your dentures exceeds your annual maximum, you can ask your dentist if the work can be split across multiple years.
Replacement dentures may be covered every five to eight years. Check with your plan to confirm coverage frequency.
Full dentures replace all the teeth in the upper or lower jaw. They sit directly on your gums and stay in place with support from your palate and the ridge of your lower jawbone. They often require denture adhesive to remain in place.
Like full dentures, partial dentures require support from your gums, jaw, and palate to remain in place. Designed for those who are missing multiple top or bottom teeth, they have special clasps that attach to your remaining natural teeth for added stability.
To avoid any surprise expenses associated with your dentures, check your dental benefits or talk to your insurance company to understand exactly what you're responsible for. That means understanding how your plan handles:
- Deductibles: When your dental insurance coverage starts, you will begin paying your deductible, as determined by your plan. You are only responsible for your coinsurance.
- Coverage percentages: Your insurance may cover a portion of the denture cost once your deductible is met. Depending on your plan, insurance may pay for 20-50% for major procedures.
- Coinsurance: After meeting your deductible, your plan may require a coinsurance payment of 50-80% of service costs, depending on your plan and whether your provider is in-network. This differs from a copay, which is a specific dollar amount due at your appointment.
Depending on your dental insurance plan, a waiting period of up to a year may be required before your insurance provides coverage for dentures.
Dental insurance may not cover claims if you:
- Receive dentures not considered clinically necessary
- Obtain dentures before your dental plan begins
- Pay premiums late
- Miss appointments, submit incomplete claim forms, or don't provide required dental records
Get reliable answers to your insurance questions, such as how to get prior authorization and submitting a claim.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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