Call to speak to a Licensed Insurance Agent
Are you considering jaw surgery and have the question, “Does Medicare cover jaw surgery?”
Jaw surgery is recommended for individuals with functional or aesthetic jaw concerns. This can include difficulty chewing or biting, frequent jaw pain or discomfort, sleep apnea, or jaw asymmetry.
Jaw surgery can also be necessary to correct congenital defects, facial trauma, or jaw tumors. The decision to undergo jaw surgery is made after a thorough evaluation by an oral surgeon. They account for the patient’s dental and medical history and a discussion of the patient’s goals and expectations.
This type of surgery, however, is not cheap, which is why many ask about Medicare coverage. Get the details about this coverage – in plain English – below. Also, find out about the average costs of jaw surgery for those who do not have insurance coverage.
Does Medicare Cover Jaw Surgery?
The short answer to that is yes. Medicare will cover the cost of jaw surgery. But this is not true 100% of the time.
As is often the case with Medicare, certain conditions have to be met for Medicare to pay for jaw surgery. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Jaw Surgery
Original Medicare (Medicare Part A and Part B) provides coverage for jaw surgery. This plan provides coverage for jaw surgery if it is considered medically necessary. First, your healthcare provider must order the operation. Only then will Original Medicare provide coverage.
Original Medicare may provide coverage for your jaw surgery for the following reasons:
- To extract a damaged or dead tooth before starting a radiation treatment to reduce the risks of mandibular death.
- To extract a damaged or dead tooth before starting an organ transplant to avoid oral infection.
- If your jaw needs to be repaired after removing a tumor
- If you have a fractured jaw that needs to be repaired
When are you Covered by Part A?
Coverage for jaw surgery is provided by Medicare Part A if your jaw surgery takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
Starting from the 61st day up to 90 days, Medicare Part A will still provide coverage. However, you will pay a copayment each day you are in the hospital. After 90 days, Medicare Part A will no longer provide coverage.
That said, Medicare Part A does provide 60 lifetime reserve days. If you have them, your hospitalization will be covered, and you’ll have a daily copayment.
When are you Covered by Part B?
On the other hand, most of the time, coverage for jaw surgery is provided by Medicare Part B. This is because it often takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of jaw surgery costs. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Jaw Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for jaw surgery. Medicare Advantage is a type of health insurance plan approved by Medicare. It is offered by private insurance companies. Medicare Advantage plans include all the benefits of Original Medicare. It also provides additional benefits, which could include vision, hearing, dental, and/or health and wellness programs.
Exactly what a Part C plan covers and how much the out-of-pocket costs will vary depending on your plan. It is best to directly check with the Medicare Advantage plan to confirm coverage and any related charges.
Some Medicare Advantage plans may require pre-authorization for certain procedures, including jaw surgery. So we recommend you work with your physician to ensure that you take the necessary steps for coverage.
How much does Jaw Surgery Cost?
The cost of jaw surgery can vary widely depending on several factors, such as the type of procedure being performed, the location of the surgery, the experience and qualifications of the surgeon, and your individual insurance coverage.
On average, the cost of jaw surgery ranges from $10,000 to $50,000 or more, although this is just a rough estimate, and actual costs can be higher or lower.
If the patient has insurance, the cost of jaw surgery may be covered in part or in full, depending on the insurance plan and the type of procedure being performed.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare cover Ablation for AFib?