Although Original Medicare (Medicare Part A and Part B) does not cover routine dental services, oral surgery may be covered by Medicare if it is determined to be medically necessary.
Below is a breakdown of how Medicare covers oral surgery and some additional options Medicare beneficiaries may have for other dental coverage.
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 plan that offers dental benefits.
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 $1,364 deductible (in 2019) 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 $185 per year in 2019 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.
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.
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