Does Medicare cover oral surgery?

Original Medicare does not cover routine dental care or oral surgery for the general health of the teeth. However, Medicare may approve coverage for oral surgery in special cases.

Although Original Medicare does not cover routine dental care, it does provide limited coverage for certain types of oral surgery.

Approved procedures and surgeries include those related to a covered health condition, such as tooth extractions before jaw cancer treatment.

As Medicare Advantage plans provide the same benefits as Original Medicare, they will typically cover the same types of oral surgery.

This article explains the Medicare coverage of oral surgery and dental care, discusses the out-of-pocket costs that may apply to approved oral surgery, and looks at other options that may help a person with dental expenses.

Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:

Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What parts of Medicare cover oral surgery?

If an individual requires oral surgery, various parts of Medicare may provide some coverage, including:

Original Medicare
Medicare Advantage
Medicare Part D prescription drug coverage
Medigap
Original Medicare
Original Medicare, which consists of Part A and Part B, does not cover dental care or oral surgery that a doctor or dentist performs primarily for tooth health.

However, it does provide some coverage if a person needs dental care to improve their general health or boost the likelihood of a good outcome from another approved service.

Surgery and dental care must be medically necessary. Examples include:

oral examinations before a heart valve replacement or kidney transplant
tooth extraction before radiation treatment for jaw cancer
reconstruction of the jaw after removal of a facial tumor
surgical repair of a jaw fracture or injury
Sometimes, a person may need a simple dental procedure to take place in the hospital for their safety. For example, a doctor may recommend that people with a severe heart disorder undergo this procedure in the hospital even though the extraction is not related to their heart condition.

In these cases, Medicare Part A covers the hospitalization but not the cost of the dental procedure.

Medicare Advantage
Medicare Advantage, also known as Part C, is an alternative to Original Medicare.

Private health insurance companies administer these plans, which provide the same benefits as Parts A and B. However, Part C deductibles, copayments, and coinsurance are often different from those of Original Medicare.

Some Medicare Advantage plans also include coverage for routine dental care, but the extent of the coverage can vary.

As Medicare only covers oral surgery in some instances, a person who needs a procedure should check whether their Medicare Advantage plan covers the costs. By contacting the plan provider, an individual can minimize their out-of-pocket costs.

Prescription drug coverage
Medicare Part A or Part D may cover someone’s prescription drugs.

If an individual needs medication during a hospital stay, Part A will cover the cost. After a doctor discharges a person from the hospital, their Part D plan covers any approved drugs that a doctor prescribes.

People with Original Medicare can add Part D prescription drug plans to their coverage for an additional premium. Unlike Original Medicare, private insurance companies administer Part D plans.

Many Medicare Advantage plans include Part D prescribed medication coverage, but not all do. People should check the extent of their coverage with their plan provider.

Medigap
If someone has Original Medicare, they can choose to add a Medicare supplement insurance policy to their coverage. However, these Medigap plans cannot supplement Medicare Advantage plans.

As with Medicare Advantage plans, private health insurance companies administer Medigap policies.

If a person with Original Medicare were to undergo an approved oral surgery, their Medigap plan might help pay the Part A and Part B deductibles, copayments, and coinsurance. However, these plans do not help pay toward routine dental care costs.

What parts of Medicare do not cover oral surgery?
Original Medicare does not pay for services relating to the care, treatment, and removal of teeth. These services include routine cleaning, checkups, fillings, tooth extractions, and dentures.

The coverage also excludes the replacement of teeth or structures that directly support the teeth. Examples include:

the removal of diseased teeth in a jaw with an infection
the removal of the teeth to prepare for dentures
secondary services, such as dentures
For example, if a doctor were to remove all of a person’s teeth to treat oral cancer, Medicare would cover the removal of the teeth on the basis of it being medically necessary to treat cancer. However, the coverage would likely not extend to dentures to replace the teeth, which Medicare classes as a secondary service.