Does Medicare Cover Oral Surgery?

Medicare does cover oral surgery in certain situations if the surgery is deemed “medically necessary.” As with most types of surgeries, Medicare coverage will depend on your circumstances.

Learn more about Medicare coverage for dental surgery and ways you may be able to get help covering some other oral care costs.

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How Medicare may cover your oral surgery

Medicare Part B (medical insurance) may provide coverage for surgery on the bones, nerves or tissue of the mouth or jaw.

In order for Medicare to cover your oral surgery, the following two requirements must be met:

  • The surgery must be deemed medically necessary
    In order to qualify as medically necessary, the surgery must be ordered or prescribed by a licensed physician or other authorized medical provider, and Medicare must agree that the procedure is indeed necessary.

  • The surgery must be performed by a doctor who accepts Medicare
    As with any service or item, the oral surgery must be performed by a doctor who accepts Medicare assignment in order for it to be covered by Medicare.

In addition, Medicare Part A (hospital insurance) may provide coverage for certain medically necessary dental procedures while a beneficiary is an inpatient in a hospital or skilled nursing facility.

Medicare coverage for routine dental care

Original Medicare (Part A and Part B) does not provide coverage for most dental care. This includes routine checkups, cleanings, fillings, tooth extractions, dentures, dental plates and other basic dental services that are not considered to be medically necessary.

Medicare beneficiaries aren’t entirely out of luck when it comes to dental care, however.

A Medicare Advantage plan (Medicare Part C) is an alternative way to get Original Medicare benefits by receiving Medicare Part A and Part B benefits through a single privately sold plan.

Many Medicare Advantage plans may also offer additional benefits not covered by Original Medicare, such as dental coverage for routine oral care. Some of these plans may also offer coverage for dentures and other dental needs.

Learn more about Medicare Advantage plans in your area that may cover oral surgery and other dental care costs by calling a licensed insurance agent at TTY Users: 711 24 hours a day, 7 days a week.

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