While original Medicare does not cover dental services 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.

Oral surgery is sometimes required as part of the treatment plan for a medical condition, such as cancer or heart disease. In these instances, it would be classified as a medically necessary procedure.

Common examples of covered oral surgery include:

  • Extraction of a damaged or diseased tooth before starting radiation treatment to help reduce the risk of mandibular (bone) death
  • Extraction of a damaged or diseased tooth before an organ transplant to help reduce the risk of oral infection
  • Repairing or restoring a fractured jaw
  • Repairing or restoring your jaw after removing a tumor

If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs.

Since each situation is different, talk with your healthcare professional, review your plan’s specific criteria, and consult your plan’s administrator to confirm coverage before surgery.

Medicare Part A

If you know you will require medically necessary oral surgery to treat an underlying condition, you may get coverage under Medicare Part A if you are a hospital inpatient.

Medicare Part B

Medicare Part B may cover outpatient medically necessary oral surgery.

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.

Not every Medicare Advantage plan includes dental services, so make sure to confirm coverage before enrollment or surgery.

Medicare Part D

Required medications, such as those for infection or pain, are covered under Medicare Part D unless administered intravenously.

Part B will cover the costs of intravenous medications administered in a hospital setting. Most Medicare Advantage plans also cover the cost of medications.

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.

You will incur all associated costs if you have oral surgery that isn’t considered medically necessary.

If your oral surgery procedure is medically necessary, there are still costs you may have to pay. For example:

  • Copays: Medicare will cover 80% of the cost of medically necessary oral surgery, provided a Medicare-approved healthcare professional performs it. If your procedure is done in a hospital and you do not have additional Medigap insurance, you will be responsible for 20% of the cost.
  • Deductible: For most people, Medicare Part B has an annual deductible of $240 in 2024 that must be met before any services, including medically necessary oral surgery, will be covered.
  • Monthly premium: In 2024, Medicare Part B’s standard monthly premium rate is $174.70. This may be less if you’re currently receiving 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 cover all or part of your medications’ costs. If you do not have drug coverage, you will be responsible for the cost of any medications required.

Original Medicare does not cover routine dental services and oral surgery procedures required only for dental health. Some Medicare Advantage plans may cover oral or gum surgery needed for tooth or gum health.

If you need medically necessary oral surgery, original Medicare may pay for the procedure. Even so, you may have out-of-pocket costs to pay.