Does Medicare Cover Oral Surgery?

Good oral health is an integral part of overall health. Unfortunately, more than half of older adults do not have dental insurance, and out-of-pocket costs for dental services have increased over the past several years. Original Medicare only pays for medically necessary dental services and procedures. Original Medicare might pay for your oral surgery to treat another health condition you may have effectively. Alternatively, many Medicare Advantage plans provide coverage for dental services.

Oral surgery may be needed for multiple reasons. For instance, you may need your wisdom teeth removed or develop an infection in a tooth that needs removal. This article will explore Medicare coverage options for those needing oral surgery.

What dental procedures does Medicare cover?

In the United States, over 65 million people are enrolled in Medicare, and most enrollees are over 65. Over the years, there have been many efforts to increase Medicare coverage of dental services. However, complete dental care is not a component of Original Medicare, encompassing Medicare Parts A and B. Original Medicare does not pay for routine dental services or procedures such as fillings and teeth cleanings.

Medicare Part A, which provides hospitalization coverage, will pay for medically necessary dental services related to an underlying health condition or a dental emergency that causes you to be hospitalized. Although Original Medicare does not provide comprehensive dental coverage, many Medicare Advantage plans do. Medicare Advantage plans are available to Medicare beneficiaries to help cover the cost of preventive and corrective dental services.

Which Medicare plans cover oral surgery?

Original Medicare only covers Medically necessary oral surgery, and you may wonder what other options are available under Medicare. Unfortunately, Medicare supplement plans, commonly called Medigap plans, do not cover oral surgery.

Oral surgery is primarily a service covered by Medicare Advantage or Medicare Part C plans. Enrollment in Medicare Advantage plans continues to rise. Over the next few years, it is anticipated that half of all Medicare beneficiaries will be enrolled in a Medicare Advantage plan. Medicare Advantage plans offer dental coverage through two different pathways: mandatory or optional supplemental dental benefits. If a plan offers mandatory supplemental dental benefits, you will receive dental coverage at no additional cost.

Alternatively, if you have a plan that offers optional supplemental benefits, you will pay an additional premium for that coverage. You can choose a plan offering optional and mandatory supplemental dental benefits for more comprehensive coverage.

Medicare Advantage plans cover various services, including extractions, oral surgery, cleanings, preventative exams, and X-rays. It is essential to be familiar with the services covered under each plan as they may vary. You should also be aware of the limits for those covered services. For instance, there will likely be a limit on the number of times you can get dental exams, X-rays, or your teeth cleaned each year. Typically, you are allowed up to two teeth cleanings per year. Annual limits on X-rays tend to be more variable among plans. Review the details of each plan carefully, as dental benefits vary across Medicare Advantage plans. Not all Medicare Advantage plans offer a dental benefit.

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Does Medicare cover tooth extraction?

Original Medicare will only pay for removal under certain conditions if you need a tooth extracted. For instance, if your tooth is infected and you need the tooth extracted before receiving an organ transplant or cardiac valve replacement, Original Medicare will pay for the removal. Otherwise, you will need dental coverage under a Medicare Advantage plan or other dental coverage to help with the costs. Many Medicare Advantage plans cover tooth extraction.

How much does oral surgery cost with Medicare?

The amount you will pay after having oral surgery is decided by your Medicare plan. Understanding certain plan elements is important to select the plan that best meets your dental coverage needs. Here are some essential components of Medicare Advantage plans that you should review:

• Premiums. You will have to pay a monthly premium to maintain your insurance each month. Your insurance company determines the premium amount, and premiums vary by insurance plan.
• Coinsurance. Coinsurance is typically paid once your deductible is met and is the percentage you will pay for the total cost of a service you receive. This is typically 20% for a service covered by Medicare Part B.
• Deductible. For some Medicare plans, you will have to pay for services out-of-pocket up to a certain amount before your insurance starts paying for services. This is called a deductible, and the amount varies by plan.
• Copayments. Like coinsurance, copayments are payments you make to cover a portion of the service you receive. However, copayments are generally fixed dollar amounts for certain visits and services. Copayments for services also vary by plan.
• Prescription medications. You may need to take prescription medications after your surgery. Medicare Part D helps cover the cost of prescription medications, and the amount of your copayment will depend on your plan.
• Plan maximums. Many plans will pay for dental services up to a specific annual limit. This is known as the yearly maximum. Once you reach this amount, you must pay for any additional dental services out-of-pocket.

Keep all these factors in mind when selecting and reviewing plans. Access to dental care is essential for older adults, and proper dental care can prevent the worsening of chronic health conditions.

Medicare beneficiaries have limited access to dental care under Original Medicare, and services such as oral surgery are not covered by Original Medicare unless medically necessary. In 2023, Original Medicare expanded its list of medically necessary services, but this expansion still does not provide comprehensive dental care.

If you need oral surgery and are enrolled or are eligible to enroll in Medicare, consider enrolling in a Medicare Advantage plan to obtain access to the necessary coverage for your procedure. With a Medicare Advantage plan, you will still receive the benefits of Medicare Parts A and B, and potentially Medicare Part D, depending on your selected plan.