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Does Medicare cover oral surgery?

"does Medicare cover oral surgery" text over image of senior woman smiling in dental chair

Just the Essentials…

  • Original Medicare generally does not cover oral surgery (or any other dental services) unless they are received in a hospital setting.

  • Put another way, Original Medicare will only cover dental surgery that is received as a result of traumatic injury or as part of an overarching covered process, such as necessary tooth extractions prior to heart surgery.

  • Luckily, there are some Medicare options, such as a comprehensive Medicare Advantage plan, that may cover oral surgery in addition to other dental care.

How important is Medicare oral surgery coverage for seniors?

If you are a current Medicare recipient, you may feel that your current coverage effectively meets your medical needs such as doctor’s appointments and hospital care, but what about coverage for additional healthcare needs? What about your teeth, for example?

The importance of having coverage for both routine dental needs, like teeth cleanings and fillings, and emergency dental surgery, like root canals and tooth extractions, cannot be understated.

The older we get, the more likely we are to encounter scenarios where this type of Medicare oral surgery coverage is necessary. Many seniors are at a higher risk for dental diseases, such as periodontitis, tooth decay, and oral cancer. 

These conditions don’t just affect your teeth, they can also limit your nutrition intake and in some cases, even increase your risk of stroke, heart attack, or diabetes. For this reason, it’s safe to say that effective dental coverage under Medicare is extremely important.

Does Medicare pay for oral surgery?

If you’re asking yourself “does Medicare cover oral surgery?”, you may be surprised to learn that the answer to this question is actually multifaceted

As a general rule, Original Medicare Parts A and B alone do not typically cover any form of dental care or oral surgery. That said, there are a few unique circumstances when certain types of oral surgery may be covered under your Traditional Medicare plan. Let’s break it down even further.

When does Medicare cover oral surgery?

Currently, dental coverage under Original Medicare is unfortunately quite limited, but there are some scenarios where certain dental procedures may be covered under your Original Medicare plan.

For example, certain forms of reconstructive dental or oral surgery may be covered under Original Medicare if they are considered to be medically necessary as a result of a traumatic injury.

Additionally, dental services that are considered to be medically necessary prior to another Medicare-covered procedure, such as doctor-ordered tooth extraction prior to heart surgery, will usually be covered. Likewise, a person with oral cancer may receive coverage for a dental procedure that is considered to be medically necessary prior to radiation treatment.

When is oral surgery not covered under Medicare?

It is important to note that even if Original Medicare does pay for some of the costs associated with dental surgery services as a result of traumatic injury or as preparation for another covered medical procedure, there is no scenario where Original Medicare will cover dental needs that are not considered by your doctor to be medically necessary (such as routine teeth cleanings or dentures).

Furthermore, any dental surgery that is not ordered by a doctor as preparation for other covered medically-necessary procedures will typically not be covered under Original Medicare Parts A and B. This includes dental needs such as fillings, crowns, root canals, dental implants, etc.

Is it possible to get more comprehensive dental surgery coverage under Medicare?

Although most oral surgery and dental care is not covered under Original Medicare Parts A and B, it is indeed still possible to receive coverage for these services under Medicare Part C, which is also known as Medicare Advantage.

Medicare Advantage plans are additional Medicare healthcare plans that are offered by private insurance companies. These plans often provide additional coverage for healthcare needs and services that are not covered under Original Medicare, including dental care and oral surgery. 

So, does Medicare cover oral surgery under Part C? Well, the following dental needs are commonly covered under Medicare Advantage plans:

  • Routine dental cleanings
  • Routine dental exams
  • Surgical tooth extractions
  • Fillings
  • Crowns
  • Root canals
  • Dentures
  • Dental implants

Keep in mind that each Medicare Advantage plan may carry different benefits, pricing, and availability, so no two plans are truly alike. That said, current Medicare law dictates that any Medicare Advantage plan must cover the same medical services that are covered under Original Medicare in addition to any extra coverage they may provide.

If you’re interested in learning more about your potential eligibility for more comprehensive health insurance coverage through Medicare Advantage, don’t hesitate to contact the licensed insurance agents at MedicareInsurance.com! 

With our professional assistance, you can begin researching and comparing a plethora of potentially available Medicare Advantage plans in your area today. Just call (800) 950-0608 to get started.

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