Does Medicare Cover Oral Surgery?
Medicare Benefits Solutions
Nov 17, 2021
Some Medicare recipients are considering oral surgery, and they wonder if they have options to help them pay for it. Original Medicare won’t cover any routine dental services that are specifically for gum or tooth health, but it could provide coverage for oral surgery if it is in relation to a medical condition.
Also, some Medicare Advantage plans have coverage for oral surgery. Since you don’t want to have a huge bill after your oral surgery, let’s break down Medicare benefits in relation to oral surgery below.
Medicare plans and oral surgery
Your doctor may recommend oral surgery as part of your treatment plan for specific conditions. These conditions include heart disease or cancer. In this case, having oral surgery would fall under the medically necessary category. A few examples in which Medicare recipients could use Medicare for their oral surgery costs include:
- To avoid getting an infection, they may have to remove a diseased or damaged tooth before you have an organ transplant
- Extraction of diseased or damaged teeth before you start radiation treatment to reduce the risk of bone death in your jaw
- Fractured your jaw, and it requires surgery to repair it
Keep in mind that each situation is different, so you want to review your specific benefits and talk to your doctor before you agree to any procedures. This will help you find out whether Original Medicare will pay for it or not.
If you are a hospital inpatient and you know that you’ll need medically necessary oral surgery as part of your treatment plan, you could get coverage for the costs through Medicare Part A benefits.
Maybe you need medically necessary oral surgery on an outpatient basis. This can be while you’re listed as an observation patient in the hospital or if you go to an outpatient surgical center. Part B benefits can pay for medically necessary oral surgery procedures in this instance.
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Medicare Advantage Plans
If you know that you’re going to need oral surgery to help maintain or improve your dental health, along with routine dental care, you may want to enroll in a Medicare Advantage plan. Many plans can cover routine dental procedures, but you’ll want to compare plan benefits and costs.
Medigap, or Medicare Supplement Plans
Medigap plans will cover your coinsurance costs and the Part A deductible if you have your surgery in a hospital setting and it’s medically necessary. If you get this surgery for your dental health only, Medigap won’t cover these costs.
Typical oral surgery costs
If you have a medically necessary oral surgery, you will have some costs associated with it to plan for. For a non-medically necessary procedure, you’ll pay the whole cost. The cost of your oral surgery can range anywhere from tooth removal at $100 to $450 up to $3,000 and more for dental implants. Even if your insurance covers it, you have to pay:
- Copays – Up to 20% of the total cost
- Deductible – Most people will pay an annual Part B deductible of $203 before Medicare will cover anything.
- Monthly Premium – Medicare Part B has a monthly premium of $148.50. This could be less for social security benefit recipients, or it could be more, depending on your income.
- Medications – You have to have Part D or another type of drug-specific coverage to have the full or part of the cost of your medications covered.
Original Medicare benefits won’t offer coverage for oral surgery or dental services that you need purely for routine dental health. However, if your oral surgery is for your gum or tooth health, some Medicare Advantage plans can offer coverage. If your oral surgery is medically necessary for your health, Medicare may help cover the costs.
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