November 29th 2023
By Ari Parker
Confused about whether Medicare covers oral surgery? Find out what you need to know in this article. Learn about coverage, costs, and other important information.
Oral surgery is fairly common — more than 10 million people undergo oral surgery every year. From tooth extractions to dental implants, there are various kinds of oral surgery. Surgeries in general can be quite costly, and Medicare dental coverage is often less than comprehensive. So, you might be wondering if Medicare covers oral surgery. Medicare provides coverage for oral surgery if it is medically necessary, improves your overall health, and you need the surgery because of another condition. We’ll explain these criteria in more detail below.
While Medicare does not pay for routine dental care and treatment, it can cover oral surgery in certain circumstances.
How much you pay out-of-pocket varies based on your specific Medicare coverage.
Medicare Part D covers prescription drugs needed after the oral surgery.
Oral surgery is defined as any surgical intervention you need in or around your mouth including teeth, gums, jaw, and surrounding facial structures.
Oral surgery includes a wide variety of procedures like teeth extractions, dental bone grafts, dental implants, periodontal surgery, corrective jaw surgery, sleep apnea surgery, and cleft lip and palate repair.
You may need oral surgery if you experience:
Excessive tooth deterioration
Gum disease
Missing or impacted teeth
Oral cancer
Bumps in the mouth
Sleep apnea
Jaw complications (specifically bone loss)
Broken teeth
Generally, Medicare doesn’t cover most dental care, but Medicare may cover oral surgery in specific situations. For example, a person may need jaw reconstruction surgery following the removal of a facial tumor. Because the surgery is closely related to another medical service that is covered, Medicare may cover the surgery to benefit the person’s overall health.
Medicare Part B covers outpatient treatments, procedures, and surgeries. If you meet conditions for Medicare to pay for your oral surgery, Part B will cover the procedure. Keep in the mind that Original Medicare (Part A and Part B) covers 80% of the costs for covered services, leaving you responsible for the remaining 20% If you have a Medigap plan, then your costs will be reduced according to your plan’s coverage benefits. For example, with a Medigap Plan G, you wouldn’t owe anything for covered services once you’ve met the Part B deductible.
Medicare Advantage plans must provide at least the same coverage as Original Medicare, and they often also include additional benefits like dental insurance. That said, coverage for oral surgery is likely limited and may require prior authorization.
Medicare Advantage out-of-pocket costs (deductibles and coinsurance) vary. Before receiving oral surgery, check in with your insurance carrier and your doctor’s billing department to get a sense of how much you’ll have to pay based on your specific Medicare insurance.
Medicare Part D is responsible for covering the prescription drugs you’ll need following oral surgery. You can receive Part D coverage through a standalone prescription drug plan or through a Medicare Advantage plan that includes it. Each Part D policy is different and covers a different set of drugs, so work with your doctor to be sure your plan will cover the prescriptions you need post surgery.
Medicare will not cover any treatment, service, or surgery directly related to teeth care. This includes services like routine cleanings, checkups, extractions unrelated to any other condition, fillings, and dentures.
How much oral surgery costs depends on the procedure, your location, and dental clinic. Dental implants are around $1,942, dental bone grafts are around $300, and tooth extractions range from $166 to $800. More intensive surgeries related to the jaw or facial reconstruction can cost upwards of $50,000.
If your oral surgery is covered by Medicare, your costs will be reduced according to your policy’s benefits. Oral surgery can be expensive and the rules around Medicare coverage can be complicated. If you still have questions, we can help! Call us at (855)-900-2427 to talk to one of our licensed Advisors and get more information on what Medicare covers.
