When Does Medicare Cover Oral Surgery?

Oral surgery may be covered by Medicare if it is determined to be medically necessary. Original Medicare (Part A and Part B) does not cover routine dental services.

Below is a breakdown of how Medicare covers oral surgery, and some additional options Medicare beneficiaries may have for other dental coverage.

Medicare may cover oral surgery if it is medically necessary

Oral surgery involves procedures performed on the bones, nerves or tissue of the jaw or mouth. When such a procedure is considered medically necessary and is performed by a Medicare-participating doctor or surgeon, it may be covered by Medicare.

Medically necessary is defined as a treatment or service that is required in order to treat a specific injury, illness, disease or condition.

• For example, if you suffer an injury that results in facial or jaw fractures and are admitted as a hospital inpatient, Medicare Part A may cover some of the costs of your hospitalization and surgery costs.
  
  
• If your oral surgery is performed in an outpatient setting, Medicare Part B may cover the surgery if it is medically necessary and is part of a Medicare-covered service.

It is important to keep in mind that Medicare will not cover oral surgery that is solely intended to treat your teeth, such as the installation of bridges, crowns or dentures.

If you require this type of surgery, you will likely pay the full cost of your treatment unless you have dental insurance or a Medicare Advantage (Medicare Part C) plan that offers dental benefits.

How much does oral surgery cost with Medicare?

As mentioned above, if you receive oral surgery while you’re a hospital inpatient, your hospital costs may be covered under Medicare Part A.

Medicare Part A carries a $1,408 deductible (in 2020) for each benefit period. You must meet this deductible before your Part A coverage begins. Once that deductible is met, there is no coinsurance requirement for the first 60 days of your inpatient hospital stay.

Oral surgery, however, is often performed in an outpatient setting. And in order to have an outpatient oral surgery covered by Medicare, you must be enrolled in Medicare Part B, which is optional coverage.

You must satisfy the Medicare Part B annual deductible of $198 per year in 2020 before Medicare Part B will cover additional costs of your oral surgery.

Once you meet your Part B deductible, you will typically pay 20 percent of the Medicare-approved cost of the surgery, and Medicare will pay for the remaining 80 percent.

Does Medicare cover tooth extraction by an oral surgeon?

Original Medicare only covers a tooth extraction if it’s considered medically necessary.

However, Medicare Advantage plans that include routine dental coverage will often cover a tooth extraction. 

Does Medicare cover removal of wisdom teeth?

Original Medicare typically will cover wisdom teeth removal only if your doctor says it's medically necessary.

As is the case with other routine dental procedures, wisdom tooth removal may be covered by a Medicare Advantage plan with dental benefits. 

What dental procedures does Medicare cover?

While Original Medicare only covers dental procedures that are considered to be medically necessary, a Medicare Advantage plan with dental benefits may provide coverage for things like:

• Oral exams
• Teeth cleanings
• Fillings
• Extractions
• X-rays
• Diagnostic services
• Root canals
• Periodontics (treatment of gum disease and oral inflammation)
• Prosthodontics (crowns, bridges, dentures and implants) 

Medicare Advantage plan availability and benefits may vary, so be sure to check with your insurance carrier or a licensed insurance agent to find out about dental coverage that may be included in Medicare Advantage plans where you live.

Medicare Advantage plans may cover oral surgery and may cover other dental care

By law, Medicare Advantage (Medicare Part C) plans must provide the same minimum benefits as Medicare Part A and Part B, with the exception of hospice care, which you still receive from Medicare Part A. This means that qualified oral surgery is covered by a Medicare Advantage plan in the same way that it is by Medicare Part A and Part B.

Some Medicare Advantage plans may also provide coverage for routine dental services such as dental exams, fillings, tooth extractions, dentures and more.

Call to speak with a licensed insurance agent and learn more about your Medicare Advantage plan options. You can find a plan that may cover your oral surgery and dental care needs.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!