Does Medicare Cover Oral Surgery?
Original Medicare typically does not cover dental care, tooth extractions or oral surgery. But Medicare will cover oral surgery if it is medically necessary for an injury or part of a procedure for a serious health condition. Medicare Advantage plans may also offer additional dental benefits.
Oral Surgery Covered by Original Medicare
Original Medicare — Medicare Part A and Part B — does not cover routine dental care, but it does help cover oral surgery in certain cases.
Medicare Part A hospital insurance helps cover emergency or complicated dental services if you are a hospital inpatient. Medicare Part B medical insurance applies when you receive services in an outpatient setting.
- Reconstruction of your jaw following an accident
- Tooth extractions necessary for radiation treatment of neoplastic diseases (diseases that cause tumor growth) in the jaw
- Certain oral examinations — but not oral treatment — prior to kidney transplant or heart valve replacement surgery in some cases
Medicare will also cover the cost of hospitalization if you have to have a tooth extracted in a hospital. This can happen if you have a serious heart or other condition that makes it safer for you to have the procedure in a hospital.
In those cases, Medicare will cover the hospitalization, but you will be responsible for the full cost of the dental procedure.
Medicare determines whether it will cover oral surgery or similar procedures based on the type of service provided and the anatomical structure — such as the jaw — on which the procedure is performed.
Medicare does not determine coverage based on the cost, value or need for the procedure.
Your Costs for Oral Surgery Under Medicare and Medicare Advantage
Your costs for oral surgery vary depending on the type of procedure and the type of Medicare coverage you have.
Even though services covered under Original Medicare do not include oral surgery, tooth extractions or other dental care in most cases, these services may be covered under a Medicare Advantage plan.
Medicare Part D prescription drug plans can also help with the cost of prescription drugs you will need following oral surgery. Medicare Advantage plans usually come with a Part D plan.
- Medicare Part A hospital insurance
- Medicare Part A covers oral surgery required for an accidental injury or if it’s needed as part of another procedure such as radiation treatment of the jaw. If the procedure is covered, and you are a hospital inpatient, you are still responsible for your Medicare Part A deductible — $1,484 in 2021.
- Medicare Part B medical insurance
- Medicare Part B covers services performed in an outpatient setting. This may include examinations required prior to a kidney transplant or heart valve replacement surgery if the examination is done by a doctor. Medicare Part A will pay if the exam is done in a hospital where you’ve already been admitted as a patient. Your costs under Medicare include your Part B deductible — $203 in 2021 — and your coinsurance, which is 20 percent of the Medicare-approved cost of the service.
- Medigap (Medicare Supplement) insurance
- Medigap — also called Medicare Supplement insurance — is private insurance that helps cover out-of-pocket expenses under Original Medicare. If the procedure is covered by Original Medicare, your Medigap policy will cover all or part of your deductibles, coinsurance and copayments. It cannot be used to pay for services Original Medicare does not cover. Check with your plan’s administrator to see what your Medigap policy will cover in your case.
- Medicare Advantage plan
- Medicare Advantage plans are required to cover everything Medicare Part A and Part B cover — but plans may include additional dental benefits. Most Medicare Advantage plans also contain prescription drug coverage. Medicare Advantage plans vary depending on the plan and where you live. You may also have to receive oral surgery services through your plan’s network.
- Medicare Part D prescription drug plan
- Medicare Part D prescription drug plans are often included in Medicare Advantage plans. You can also buy one if you have Original Medicare. Part D plans can help cover prescription drugs you take after you get home from surgery. Each Medicare Part D plan has its own list of covered drugs, known as a formulary.
Medicare Advantage and Medicare Part D prescription drug plans are sold by private insurers. You should check with your plan’s administrator to see exactly what your plan covers.
When Original Medicare Will Not Cover Oral Surgery
Typically, Medicare covers dental services only if the dental procedure makes hospitalization necessary. Medicare will not cover the cost of dentures or other dental appliances even if the procedure results in the need to have your teeth replaced.
In that case, and in most cases of dental care, you are responsible for 100 percent of the cost of dental services.
- Dental plates
- Other dental devices
- The cost of preparing the mouth for dentures
- Directly repairing structures that support your teeth
- Directly repairing teeth (including fillings)
- Tooth extractions, except to prepare the jaw for radiation treatment of neoplastic disease
Congress specifically barred Medicare from covering all dental services when it originally set up Medicare in the 1960s. In 1980, Congress made the exception for Medicare to cover inpatient hospital services if the dental procedure itself makes hospitalization necessary.
4 Cited Research Articles
- West, M. (2020, July 20). Does Medicare Provide Coverage for Oral Surgery? Retrieved from https://www.medicalnewstoday.com/articles/does-medicare-cover-oral-surgery
- U.S. Centers for Medicare & Medicaid Services. (2013, November 19). Medicare Dental Coverage. Retrieved from https://www.cms.gov/Medicare/Coverage/MedicareDentalCoverage
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Dental Services. Retrieved from https://www.medicare.gov/coverage/dental-services
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance