Does Medicare Cover Oral Surgery?

Christian Worstell

by Christian Worstell | Published September 16, 2020 | Reviewed by John Krahnert

Medicare typically won't cover your oral surgery unless it's deemed medically necessary by your doctor.

Original Medicare (Part A and Part B) typically does not cover dental care, dental procedures or dental supplies. Read on to learn if your oral surgery could be be covered by Medicare.

What Oral Surgeries Are Considered Medically Necessary?

While routine dental care is outside of what Medicare will help pay for, Medicare may cover certain medically necessary procedures related to dental care. This could include oral surgery in some cases.

Some examples of oral surgery that may be covered include:

  • Dental splits and wiring that result from jaw surgery
  • Surgery to repair jaw or facial fractures
  • Oral surgery to treat a disease like oral cancer
  • Jaw reconstruction as part of a facial tumor removal

It's important to keep in mind, however, that every circumstance is different.

The best way to know whether your surgery is covered is to speak with the physician who ordered the surgery. Before you seek treatment, ask for a written quote of what the surgery will cost, and whether or not they participate in Medicare.

What Will Medicare-Covered Oral Surgery Cost?

Even if Medicare covers your oral surgery, there are some out-of-pocket costs that may be left to you, including your Medicare Part B deductible and coinsurance.

In 2020, the Part B deductible is $198 per year. Your Part B deductible must be paid before Medicare will begin paying its share. Once your deductible is met, you'll pay 20 percent of the Medicare-approved amount of a service (known as your Part B coinsurance), and Medicare will pay 80 percent.

Medicare Advantage and Oral Surgery

Medicare Advantage plans (Medicare Part C) are sold by private insurance companies and replace your Original Medicare coverage. Part C plans are required to offer at least the same benefits as Original Medicare, and most plans also include additional benefits such as prescription drug coverage, vision and hearing benefits.

Many Medicare Advantage plans may also cover routine dental care, including oral surgery

Medicare Advantage plans that offer dental benefits may cover things like dental exams, fillings, dentures, tooth extractions and some non-emergency oral surgeries that Original Medicare doesn't cover.

Be sure to speak with your Medicare Advantage plan carrier directly, as well as your doctor, to determine whether your Medicare Advantage plan will cover your oral surgery.

Medigap Plans and Oral Surgery

Medigap plans (also called Medicare Supplement) are insurance plans that work alongside your Original Medicare coverage to help fill in the "gaps" of Medicare deductibles, coinsurance, copays and more.

Medigap plans don't typically cover health services such as oral surgery. If your oral surgery is covered by Medicare, however, a Medigap plan could help you save potentially large amounts of money on the out-of-pocket Medicare costs for your surgery.

As mentioned above, you're typically responsible for 20% of the Medicare-approved amount if your oral surgery is covered by Medicare. This 20% copay could add up quickly. A Medigap plan that covers your Medicare Part B coinsurance would pay for those costs.

Call to speak with a licensed insurance agent to learn more about how a Medigap plan could help you pay for your Medicare-covered oral surgery, as well as other Medicare out-of-pocket costs. You can also compare plans online for free, with no obligation to enroll.

Medigap plans can help cover out-of-pocket oral surgery costs.

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