For most people, oral hygiene is thought of as simply a matter of brushing one’s teeth at least once a day, but the truth is that good oral health involves taking care of other parts of the mouth, including the gums. Gum tissue is often an indicator of not only oral health, but also of overall health. Conditions like bleeding gums can lead to infections and pain, and receding gums can also lead to loose teeth that may become weak. To make matter worse, gum diseases can cause difficult chewing, leading some people who suffer from gum problems to experience malnutrition.

Because of these problems and more, it’s imperative to care for the gums on a daily basis in addition to the teeth and other parts of the mouth. Unfortunately, some gum problems become so advanced that routine care alone is not enough to correct them. When this occurs, gum surgery may be an option to restore damaged gum tissue or to repair underlying problems with teeth roots and other underlying tissue.

Does Medicare Cover Gum Surgery?
Because oral health problems often affect older Americans who are Medicare recipients, the question of whether or not Medicare covers gum surgery often gets discussed in dental clinics. In general, Medicare does not provide dental care coverage, but it does provide coverage for surgery that is deemed medically necessary. As a result, Medicare will typically cover gum surgery if it can be demonstrated that the procedure is necessary to preserve life or treat a serious condition.

Like with non-dental surgical procedures, Medicare provides this coverage under Part B, the outpatient benefit. If prescription medications are required before or after gum surgery, Medicare benefits under Part D would apply. If the surgery were to take place in conjunction with a hospitalization or stay in a skilled nursing facility, Medicare Part A may apply, but this would depend largely on the situation and whether or not the procedure was necessary in the treatment of the original cause for the admittance. If the procedure is not a necessity at the time of hospitalization and could reasonably take place outside of the hospital setting, coverage may not apply.

Do Medicare Advantage Plans Offer Additional Benefits?
While Original Medicare benefits adhere to guidelines set forth by the program on a federal level, Medicare Advantage plan providers may be able to offer additional benefits, including some dental care. In many cases, these benefits come in the form of discounts on preventive care, but each plan and plan provider is different, so you will need to discuss your needs with your plan manager for specific details regarding your benefits.

Dental Discount Plans
Another option to pay for dental care, including gum surgery, is to work with dental service providers that offer a discount membership program. These dentists often provide services within a network of specialists that work together to treat patient’s dental care needs from routine cleanings and exams to surgery. By staying within the network of care providers and adhering to a routine schedule of care, you may be able to access discounts on each service that are comparable to dental insurance rates. To learn more, discuss your needs with your dentist or search for dental networks in your area.

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Does Medicare Advantage Cover Dental Care? (Opens in a new browser tab)