Does Medicare Cover Oral Surgery?

• by Christian Worstell
• October 17, 2023
• Reviewed by John Krahnert

Potentially. 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 $1,600 deductible (in 2023) 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 $226 per year in 2023 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?

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

However, Medicare Advantage plans can offer benefits not found in Original Medicare. 

Does Medicare cover wisdom teeth removal?

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

Again, Medicare Advantage plans can cover benefits not covered by Original Medicare. Read more about whether medicare covers wisdom teeth removal!

How to get dental work covered that is not medically necessary

While Original Medicare only covers dental procedures that are considered to be medically necessary, a Medicare Advantage plan may provide coverage for things not covered in Original Medicare. 

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.

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 Medicare Advantage plans where you live.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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