Does Medicare Cover Oral Surgery?

Original Medicare doesn’t cover routine dental care. In fact, coverage for any dental related service is rare. But what about oral surgery?

Well, a common question many people have is, “Does Medicare cover Oral Surgery?” In this article, we answer that question in clear, plain English. You will also find the average cost of oral surgery and other helpful info.

Does Medicare Cover Oral Surgery?

The short answer is yes; Medicare will cover the cost of oral surgeries. But not 100% of the time. As is often the case with Medicare, certain conditions must be met in order for Medicare to pay for your oral surgery. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for oral surgery.

Though most of the time Original Medicare does not provide coverage for many dental services, it does cover oral surgery. However, for Original Medicare to provide coverage for your oral surgery, it has to be medically necessary to treat a medical condition. Here are some medically necessary reasons for which Original Medicare may provide coverage for your oral surgery:

The extraction of a damaged or dead tooth may be medically necessary before starting a radiation treatment to reduce the risks of mandibular death
The extraction of a damaged or dead tooth may be medically necessary before 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

Because each reason is different, we recommend that you talk first to your healthcare provider to find out if Original Medicare will provide coverage for your oral surgery.

Medicare Part A provides coverage for your oral surgery if it takes place in an inpatient setting.

If the oral surgery takes place in an outpatient setting, then Part B will pick up the tab. Medicare Part B also provides coverage for intravenous medications you may need during the surgery (even if they are given in a hospital setting).

Once approved by Medicare Part B, they will cover 80 percent of the costs of your oral surgery. You will pay for the remaining 20 percent.

Medicare Advantage Plans

Medicare Advantage plans (Medicare Part C) also provide coverage for oral surgery. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and how much the out-of-pocket costs will vary depending on the specifics of your plan.

Many, but not all, Medicare Part C plans offer coverage for dental services. Medicare Part C plans that do not offer dental coverage will still provide coverage for oral surgeries as long as you meet the guidelines above.

Medicare Part D plans may provide coverage for medications that you need after oral surgery. This includes pain and infection medications as long as they are not given intravenously.

How Much Does Oral Surgery Cost?

Oral surgery costs will vary depending on how many teeth are involved, where in the mouth the surgery will take place and what type of facility the surgery takes place in.

Simple tooth extraction usually costs from $150 to $300 per tooth. More involved surgical operations can range from $225 to $2300.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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.