When most people think of oral health, they think of routine dental maintenance and light dental work, including cleanings, fillings and even crowns; however, dental surgery, and jaw surgery specifically, account for a large percentage of dental health procedures each year across the United States. Jaw surgery may be required to correct facial and structural deformities that impact speech, chewing and even breathing. Beyond that, jaw surgery may be required when teeth become impacted or when facial trauma has caused fractures or breaks.
Left untreated, jaw problems can become significantly worse in a relatively short amount of time due to the amount of movement required of the jaw. Everything from speech to breathing requires proper alignment and reinforcement of the jaw bones and associated muscles, so injured jaw areas don’t have a much of a chance to rest and heal as they are required for everyday activities. This is why some treatments to heal injured jaws require them to be wired shut or for special dental appliances to be utilized. This is done after jaw surgery in order to prevent new injuries or to prevent a re-occurrence of injury.
Medicare Coverage for Jaw Surgery
Because jaw surgery is so vital to oral and overall health, it often requires the skills and advanced equipment of a specialized surgeon. This also means that these procedures can be costly, leaving many patients, especially those on Medicare, to wonder about paying for surgery.
The good news is that Medicare does provide coverage for jaw surgery in most circumstances. As is the case with most Medicare-related procedures, the surgery needs to be deemed medically necessary to qualify, meaning people who want to receive surgery for cosmetic jaw shaping will not qualify to have surgery or related expenses covered by the program. Individuals who need surgery due to an injury or a worsening medical condition can usually have the procedure and rehabilitation costs covered by Medicare Part A and Part B.
Hospital Costs and Skilled Nursing
It should be noted that, while Medicare Part B coverage helps pay for outpatient procedures, there may be times when someone receiving jaw surgery will need to have the procedure completed in a hospital setting along with a temporary stay in a skilled nursing facility. This is often the case when someone needs special monitoring during healing or rehabilitation, but it could also occur when a jaw injury requiring surgery is secondary to a condition that finds the patient in a hospital, such as when a vehicle accident has caused other injuries in addition to jaw injuries.
Medicare Part A may be responsible for coverage during the time the patient spends as an inpatient in a hospital or skilled nursing facility. Medicare coverage under both Part A and Part B may be used to help pay for pre- and post-op care, surgery and recovery.
How Much Does Medicare Cover for Jaw Surgery?
If you have Original Medicare, jaw surgery will be covered like most other surgical procedures at 80%, leaving the patient to cover the remaining 20% of the cost. If you have purchased a Medigap supplemental insurance, it may help pay for some of the out-of-pocket costs.
Many Medicare recipients choose to get their Part A and Part B benefits through a Medicare Advantage plan. Medicare Advantage plans are required to provide at least the same Part A and Part B coverage as Original Medicare, but many offer additional benefits, as well.