If you are a Medicare beneficiary, you should know that Original Medicare does not cover dental or oral health services. However, special cases can cause Medicare to approve coverage for oral surgery. The procedure must be medically necessary as part of another Medicare-covered health condition.
Below, we review all parts of Medicare and how they play a role in oral surgery coverage.
Is Oral Surgery Covered by Medicare?
Whether Medicare covers oral surgery depends on many factors. In the typical sense, Medicare does not provide coverage for dental services. This includes oral surgeries or procedures performed by an oral surgeon.
If a physician deems oral surgery or a similar procedure medically necessary as part of a more significant health condition that Medicare typically covers, then it would receive coverage from Medicare Part B.
Cost of Oral Surgery with Original Medicare
The cost of your Medicare-approved oral surgery can vary based on different factors. If you receive oral surgery at a hospital as an inpatient, Medicare Part A covers your hospital costs. You would then be responsible for the Medicare Part A deductible and any other costs accrued.
However, in most cases, oral surgery is an outpatient procedure. If this is the case for you, you must have Medicare Part B to receive coverage. You will be responsible for paying the Medicare Part B deductible. Once you meet the annual Medicare Part B deductible, you are responsible for 20% of any remaining costs.
Medicare Supplement Oral Surgery Coverage
Since Medicare Supplements only cover what Original Medicare covers, there is also no coverage for dental or oral surgery with a Medicare Supplement plan. However, if Original Medicare decides to cover your oral surgery as part of a larger health issue, your Medicare Supplement plan will cover the gaps.
Depending on which Medicare Supplement plan you have, you can be left with few to no out-of-pocket costs.
If Medicare does not cover your oral surgery, you are not out of options. Many Medicare Supplement plan enrollees also enroll in stand-alone dental, vision, and hearing plans that offer additional coverage to beneficiaries.
Dental, vision, and hearing plans are guaranteed issue plans, meaning there are no health questions to enroll in the plan. Although anyone can enroll in these plans, they are ideal for those on a Medicare Supplement plan. When you enroll in one of these plans, you not only receive the great benefits from your Medicare Supplement plan, but you also receive coverage for the biggest holes in Original Medicare.
There are several carriers who offer dental, vision, and hearing plans. Thus, it is important to speak with a licensed agent to review which plan and carrier are best for you.
Medicare Advantage Oral Surgery Coverage
Across the country, there are several Medicare Advantage plans that provide beneficiaries with dental coverage as an additional benefit to their health plan. For plans with this benefit, there is no requirement for oral surgery to be a part of a larger medical issue to receive coverage.
Each Medicare Advantage plan is different, offering a unique range of benefits. Before scheduling an oral surgery procedure, you should contact your carrier and review the terms of your coverage to ensure your procedure will receive coverage from your plan.
Even with dental coverage, you may be responsible for out-of-pocket expenses. These can include copayments, meeting a deductible, or paying coinsurance for any oral procedure you receive. Often, those on Medicare Advantage will enroll in additional dental, vision, and hearing coverage on top of the extra benefits their plan provides. In many cases, Medicare Advantage dental coverage only covers the basics. So, it is important to have additional coverage in the case of a more expensive oral surgery.
Medicare Part D Oral Surgery Coverage
Medicare Part D does not cover any of the medical portions of oral surgery. However, if you need medications due to oral surgery, your Medicare Part D plan will help cover the cost of those prescription drugs.
Medicare Part D only provides coverage for prescription medications. The prescription drug plan in which you enroll will determine the costs of your medications. Each plan covers medications differently, so always review your plan’s formulary and speak with your oral surgeon about the best prescriptions for your situation.
How to Receive Additional Coverage for Oral Surgery
If you are a Medicare enrollee and have concerns about the costs of a potential oral surgery procedure, it is important to receive coverage as soon as possible. Often, additional dental coverage can have a waiting period before you receive care.
To find the best dental coverage for your needs, don’t hesitate to call our licensed agents to speak about your options. We are here to help! You can reach us at the number above or complete our online rate form to receive more information today.
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- Dental Services, Medicare. Accessed February 2022.
- Medicare and Dental Coverage, KFF. Accessed February 2022.