If you are a Medicare beneficiary considering oral surgery, you may be eligible for financial aid to cover the costs.
While original Medicare does not cover necessary dental services, particularly those related to tooth and gum health, it may cover oral surgery for medical conditions, such as diabetes or heart disease. Additionally, some Medicare Part C (Medicare Advantage) plans include dental coverage as an added benefit.
Let us have a look at the many forms of oral surgery that Medicare covers and why.
Do Medicare Advantage plans provide coverage for oral surgery?
Oral surgery may be necessary as part of a therapy plan for medical issues including cancer or heart disease. In certain circumstances, this type of oral surgery would be can be a medically essential procedure.
The following are some instances where Medicare may cover oral surgery:
- When the extraction of a broken or diseased tooth is medically necessary, before beginning radiation treatment
- If you have a fractured jaw and require surgery, Medicare will cover the costs of the procedure.
- If your jaw requires repair or restoration following tumor removal, Medicare will cover the cost of the treatment.
Because every circumstance is unique, you should consult with your doctor or check the particular criteria of your plan.
Medicare Part A.
If you know that you will undergo medically necessary oral surgery to treat a medical condition, you may be eligible for coverage under Medicare Part A; if you are admitted to a hospital as an inpatient.
Medicare Part B.
It is a health insurance plan that provides coverage for hospitalization and medical expenses.
Medicare Part B may be able to reimburse you for medically necessary outpatient oral surgery.
Medicare Part C.
Choosing a Medicare Advantage plan (Medicare Part C) that covers basic dental operations may be the best option for you. Specifically, if you know you will need oral surgery for dental health reasons in the near future.
On the other hand, every Medicare Advantage plan does not include dental services.
Medicare Part D (Medicare Prescription Drug Plan).
Unless they are administered intravenously, necessary medications such as those used to treat infection or pain will be covered under Medicare Part D coverage.
If you’re given medications in a hospital setting that are administered intravenously, Part B will cover the expenses of administration and prescriptions of treatment. The majority of Medicare Advantage plans also cover the cost of drugs prescription.
Supplemental Medical Insurance (Medicare) (Medigap).
If you require medically essential oral surgery in a hospital setting, Medigap may be able to cover your Part A deductible and coinsurance fees under certain circumstances. Medigap does not cover these expenses for oral operations that are necessary just for dental health.
If you have Medicare, what are your out-of-pocket expenses for oral surgery?
If you have an oral surgical operation that is not medically essential, you will be responsible for all of the costs of the procedure.
Even if your oral surgery procedure is medically necessary, you may still have to pay certain expenses. As an illustration:
- Copays: The Medicare program will reimburse up to 80% of the cost of medically essential oral surgery— if a Medicare-qualified physician performs it, and the Medicare program approves the procedure. The cost of your operation will be 20 percent of the total cost if it is performed in a hospital and you do not have supplementary Medigap insurance.
- Deductible: In most cases, Medicare Part B has an annual deductible of $203 that you must satisfy before the insurance provider covers many services, including medically necessary oral surgery.
- Monthly fee: Medicare Part B has a regular monthly premium rate of $148.50, which the federal government sets. If you’re currently getting social security benefits, the cost of this may be lower or higher for you, depending on your current income.
- Medications: To have all or part of the cost of your drugs covered by Medicare Part D or another type of drug coverage, you must have Medicare Part D or another type of drug coverage. Any medications that the doctor prescribes will be your responsibility if you do not have prescription drug coverage.
Medicare Part A does not cover basic dental services, or oral surgery procedures performed merely to maintain dental health. Some Medicare Advantage plans may pay for oral surgery that is necessary to keep your teeth or gums healthy.
If you require medically necessary oral surgery original Medicare may cover the cost of the treatment. Despite this, you may have to pay out-of-pocket expenses.