If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs.
While original Medicare does not cover dental services that are required specifically for tooth or gum health, it may cover oral surgery for medical conditions. Some Medicare Part C (Medicare Advantage) plans also offer dental coverage.
Let’s explore which types of oral surgery Medicare covers and why.
Oral surgery is sometimes required as part of the treatment plan for a medical condition, such as cancer or heart disease. In these instances, an oral surgery would be classified as a medically necessary procedure.
Some examples of when oral surgery is covered include:
- Extraction of a damaged or diseased tooth may be medically necessary prior to starting radiation treatment. This may help reduce the risk of mandibular (bone) death.
- To avoid getting an oral infection, extraction of a damaged or diseased tooth may be required prior to having an organ transplant.
- If you have a fractured jaw and you need surgery to repair or restore it, Medicare will cover those costs.
- Medicare will also cover oral surgery if your jaw needs to be repaired or restored after the removal of a tumor.
Since each situation is different, talk to your doctor or review your plan’s specific criteria, in order to determine if your oral surgery will be covered by original Medicare.
Medicare Part A
If you know that you will require a medically necessary oral surgery to treat a medical condition, you may get coverage under Medicare Part A if you are a hospital inpatient.
Medicare Part B
If you need to have medically necessary oral surgery performed on an outpatient basis, Medicare Part B may cover it.
Medicare Part C (Medicare Advantage)
If you know that you will require oral surgery for dental health, a Medicare Advantage plan (Medicare Part C) that covers routine dental procedures may be best for you.
However, not every Medicare Advantage plan includes dental services.
Medicare Part D
Required medications such as those to treat infection or pain will be covered under Medicare Part D, unless they are given intravenously.
If you are given medications in a hospital setting that are given intravenously, Part B will cover those costs. Most Medicare Advantage plans cover the cost of medications as well.
Medicare Supplement (Medigap)
Medigap may cover your Part A deductible and coinsurance costs if you have a medically necessary oral surgery performed in a hospital. Medigap does not cover these costs for oral surgeries required for dental health only.
If you have an oral surgery procedure that is not considered medically necessary, you will incur all of the costs associated with it.
If your oral surgery procedure is medically necessary, there are still costs you may have to pay. For example:
- Copays. Medicare will cover 80 percent of the Medicare-approved cost of a medically necessary oral surgery, provided that it is performed by a Medicare-approved provider. If your procedure is done in a hospital and you do not have additional Medigap insurance, you will be responsible for 20 percent of the cost.
- Deductible. For most people, Medicare Part B has an annual deductible of $203 that must be met before any services, including medically necessary oral surgery, will be covered.
- Monthly premium. Medicare Part B has a standard, monthly premium rate of $148.50. This may be less for you if you are currently getting social security benefits, or it may cost you more depending on your current income.
- Medications. You must have Medicare Part D or another type of drug coverage to have all or part of the cost of your medications covered. If you do not have drug coverage, you will be responsible for the cost of any medications required.
Routine dental services and oral surgery procedures required only for dental health are not covered by original Medicare. But oral surgery that is needed for tooth or gum health may be covered by some Medicare Advantage plans.
If you need a medically necessary oral surgery for medical health reasons, original Medicare may pay for the procedure. Even so, you may have out-of-pocket costs to pay.