Does Medicare Cover Oral Surgery?
- Medicare covers oral surgery that's medically necessary. Find out if extractions, root canals, dental implants and jaw reconstructions are covered by Medicare.
Many older adults depend on Medicare to help pay for the costs of health care. While routine dental is excluded from Original Medicare, people who need more advanced dental treatments and procedures often ask if Medicare covers oral surgery.
The amount you pay for oral surgery depends on whether Medicare considers it:
- Medically necessary
- Related to dental health
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Does Medicare Cover Oral Surgery?
Oral surgery that's considered medically necessary is covered by Original Medicare (Parts A and B).
Oral surgery related to dental health isn't covered by Original Medicare, but may qualify as a supplemental benefit through some Medicare Advantage (Part C) plans.
Oral Surgery Related to Dental Health
The most commonly performed oral surgeries are related to dental health, such as:
- Tooth extractions due to decay, disease, injury or overcrowding
- Dental implants
- Root canals
- Crowns, bridges and veneers
- Cosmetic reshaping of teeth
- Gingivectomy (removal of gum tissue)
- Gingivoplasty (reshaping of gum tissue)
- Soft tissue grafts
Cost Under Original Medicare
You must pay 100% of the cost of oral surgery related to dental health if you have Original Medicare, which is delivered through the federal government.
Cost Under Medicare Advantage
Some Medicare Advantage plans, also called Medicare Part C, may cover oral surgery for dental health. Medicare Advantage plans are offered by private insurers as an alternative to Original Medicare and include:
- Part A and Part B coverage
- Supplemental benefits such as dental, health and vision
Not all Medicare Advantage plans offer dental benefits, so be sure to check the terms of your policy. The types of dental benefits also vary. Some plans may cover only preventive dental services, such as cleanings and X-rays.
About 2 out of 5 Medicare Advantage plans offer comprehensive dental for restorative procedures, according to the Kaiser Family Foundation. If your Medicare Advantage plan covers oral surgery, your out-of-pocket cost will vary depending on your deductibles and copays.
Medically Necessary Oral Surgery
Medicare covers oral surgery if it's medically necessary as part of treatment for an existing condition. For example, a doctor may recommend:
- Extraction of a tooth prior to radiation treatment for cancer in the jaw
- Surgery to repair or reconstruct a fractured jaw
- Corrective surgery after removing a facial tumor
If it's determined oral surgery is required as part of broader medical treatment, it's covered through Original Medicare and Medicare Advantage plans.
Because Medicare covers oral surgery on a limited basis, it's best to see if your specific situation is considered medically necessary by consulting directly with Medicare at 1-800-633-4227 or your private health plan.
Find Medicare Advantage Plans
Visit MedicareAdvantage.com to compare multiple Medicare Advantage plans, side by side.
