Dental health not only includes routine care, like cleanings and X-rays, it can help diagnose more severe medical issues that may require oral surgery. If your annual dental check-up leads to a more serious need for oral surgery, your dentist will likely refer you to a specialist. An oral surgeon can perform tooth extraction, corrective jaw surgery, dental implants, or biopsies if needed. Medicare may have different coverage rules for oral surgery than for routine dental care, so understanding your benefits can help you determine your costs.

Understanding Oral Surgery

Oral or maxillofacial surgery covers a broad range of treatments and procedures that address issues that affect the teeth, gums, jaw, and facial bones. Typically, surgery is the last resort when disease, decay or damage from an injury or a defect is not able to be treated with alternative care. Oral surgeons specialize in medically necessary care, but many also perform elective and cosmetic procedures depending on the circumstances and the needs of the patient.

In most cases, oral surgery takes place on an outpatient basis. An oral surgery procedure that is being performed as part of a treatment plan for a more complex or serious health condition may take place during a hospital stay.

Common Oral Surgery Procedures                      

While oral surgeons can perform a wide range of surgical procedures, these are a few of the most common circumstances that require their specialized skills:

  • Extraction. Although some general dentists may perform simple extractions in their office, most will refer you to an oral surgeon for complex tooth extractions and impacted wisdom teeth.
  • Corrective. Fractures of the face and jaw may require wiring or dental splits to help you heal completely and properly.
  • Restorative. Removing certain tumors in the mouth or face, and then reconstructing the impacted area, also fall under the scope of treatments performed by oral surgeons.

Medicare Coverage for Oral Surgery

Although Original Medicare benefits under Part A and Part B do not cover routine or cosmetic dental care, there are certain instances in which oral surgery qualifies for coverage with these benefits. These circumstances usually involve a covered medical condition that requires oral surgery as part of a broader treatment plan, as is the case with extracting damaged teeth before radiation treatment or organ transplant.

If you require oral surgery to repair or restore your jaw due to a fracture or tumor removal, Medicare also considers this a medically necessary procedure and provides coverage. Medicare Part A covers hospital costs in cases like these after you have been formally admitted as an inpatient. Medicare Part B may cover any outpatient diagnostic tests or services to establish medical necessity for surgical intervention. A Part D Prescription Drug Plan would cover any approved medications that may be prescribed to you before or after an oral surgery procedure.

How Medicare Advantage May Help

Medicare Advantage (MA) plans are required to include the same Part A and Part B benefits as Original Medicare, but many include additional benefits. While these extra benefits often include routine dental care, not all of these plans provide coverage for oral surgery. Because Medicare Advantage plans are offered by private insurance companies that contract with Medicare, premiums and cost-sharing amounts, like copayments, can vary. By comparing benefit packages offered by the MA plans in your area, you can determine which insurer offers the coverage that best meets your specific needs.

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