Does Medicare Cover Oral Surgery?

Oral surgery is a specialized field of dentistry that focuses on the diagnosis and treatment of various conditions affecting the mouth, jaws, face, and neck.

As seniors age, they may find themselves in need of such procedures to maintain their oral health or address specific issues like impacted teeth or facial fractures. 

Does Medicare Cover Oral Surgery?

Original Medicare (Part A and Part B) typically does not cover dental care, dental procedures or dental supplies unless deemed medically necessary by a doctor.

However, Medicare may provide coverage for certain oral surgeries in specific situations. The common types of oral surgeries that might be covered by Medicare, including:

• Dental splits and wiring due to jaw surgery
• Repairing jaw or facial fractures
• Treating diseases such as oral cancer
• Jaw reconstruction for facial tumor removal

Understanding the Part B Deductible & Coinsurance

In 2024, the Medicare Part B deductible is $240 per year. This amount must be paid before Medicare begins covering its share of your medical expenses.

Once you meet this annual deductible, you'll typically pay a 20% coinsurance fee on any remaining costs associated with your procedure.

This out-of-pocket expense could add up quickly depending on the complexity and cost of your specific case. 

For example, if an oral surgery has a total cost of $5,000 after being approved by Medicare, then once your deductible is met ($240 in 2023), Medicare would cover $3,808 (80%) and leave you with a coinsurance payment responsibility of $1,192 (20%).

Exploring Medigap Plans for Dental Surgery Costs

If you're considering a Medigap plan to help with the costs of dental surgery, it's important to understand how these plans work and their limitations.

Medigap plans are supplemental insurance policies designed to fill in the gaps left by Original Medicare coverage. However, they typically do not cover health services such as oral surgery directly.

That being said, if your oral surgery is covered by Medicare, a Medigap plan can potentially save you large amounts on out-of-pocket expenses associated with your procedure. These savings come from covering some or all of the following:

• Medicare Part B coinsurance: Once your deductible is met, you'll likely pay 20% of the Medicare-approved amount for your oral surgery (your Part B coinsurance). A Medigap plan that covers this expense could significantly reduce your out-of-pocket costs.
• Deductibles: Some Medigap plans may also help cover deductibles associated with both Parts A and B.
• Copayments: Certain copayments required under Original Medicare may be covered by a Medigap policy.

To find a suitable Medicare Supplement plan, compare different options available in your area based on premiums and benefits offered.

Keep in mind that each state has its own rules regarding which types of plans are available and what they must cover. A licensed insurance agent can help you research thoroughly before making a decision.

FAQs

What are the topics related to oral surgery?

Oral surgery encompasses various procedures, including dental implants, wisdom teeth removal, corrective jaw surgery, treatment of temporomandibular joint disorders (TMJ) and cleft lip/palate repair.

Additionally, it involves diagnosing and treating oral infections or diseases like cysts and tumors.

What is interesting about oral surgery?

Oral surgery offers a unique blend of dentistry and medicine that focuses on improving patients' quality of life by addressing complex facial issues. It combines surgical expertise with an understanding of aesthetics to restore function while maintaining appearance.

What are the areas of research in oral surgery?

Prominent areas in oral surgical research include regenerative techniques for bone grafting or tissue engineering; innovations in implant technology; advancements in pain control methods during surgeries; novel diagnostic tools like 3D imaging; and genetic studies exploring predispositions towards certain conditions.