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Medicare and Oral Surgery

Dental health includes advanced procedures as well as routine care such as cleaning and X-rays that can help in the diagnosis of the underlying medical issues. In such cases, the patient may need oral surgery to correct the problem.

When the routine dental check-up reveals a more serious condition that needs oral surgery, the dentist may refer you to an oral surgeon. The common oral surgeries include tooth extraction, dental implants, corrective jaw surgeries, and biopsies. The Medicare coverage for these procedures depends on the rules and the types of oral surgery as given below:

oral surgeon

Types of oral surgeries

Oral surgeries cover a range of procedures and treatments aimed at addressing the issues affecting the teeth, jaw, gums, and facial bones. Surgery is often the last resort when the decay and damage from a defect or injury can not be treated with medications. Oral surgeons provide specialized medical care in such cases and perform cosmetic and elective procedures depending on the condition and the specific needs of the patient.

Oral surgeries are usually performed on an outpatient basis. The procedure to be performed as a part of the comprehensive treatment plan for a more serious and complex health condition may require a hospital stay.

Does Medicare Cover Oral Surgeries?

Cosmetic and routine dental care is not covered by the Original Medicare benefits of Part A and Part B. However, there are some instances in which oral surgery can qualify for Medicare coverage. These circumstances typically involve a medical condition that needs oral surgery as a part of a broad treatment plan.

For example; extraction of a damaged tooth can be performed before organ transplant or radiation therapy as a part of the comprehensive treatment plan.

If oral surgery is recommended to repair and restore the jaw damaged due to fractures or tumor removal, it is considered a medically necessary procedure by Medicare and hence, would be covered.

Part A of Medicare covers hospital costs when the patient is admitted as an inpatient while part B of Medicare may cover some of the costs related to the outpatient diagnostic tests and services performed to establish the medical necessity for the oral surgery.

The Part D Prescription Drug Plan would provide coverage for the approved medications prescribed for the patient before or after the oral surgery.

Medicare Advantage Plans

Medicare Advantage plans include the benefits provided by Part A and Part B of Original Medicare along with a few additional benefits. These extra benefits may include routine dental care. However, not all Medicare Advantage plans cover oral surgeries. Also, the premiums, co-payments, and other cost-sharing amounts of Medicare Advantage plans can vary as they are offered by the private insurance companies, which contract with Medicare.

You can compare the benefits offered by the different Medicare Advantage Plans to find out which insurer provides the coverage that meets your needs.


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