Will Medicare Cover Dental Surgery?

Most Medicare beneficiaries don’t realize Medicare doesn’t cover routine dental care. Yet according to the Centers for Disease Control and Prevention (CDC), only about 29% of Medicare-age seniors had dental insurance in 2017. However, more than double that had a dental visit in the last year.

Many age groups often overlook dental care as an essential part of health care, but especially seniors. However, dental care is vital for overall good health. Although Medicare doesn’t cover most dental care services, there are a few circumstances in which Medicare may cover a routine dental service or even dental surgery.

Common dental surgeries

Dental surgery includes a wide range of procedures, some medical, and some cosmetic. There are a few common dental surgeries that seniors tend to need more than others. Teeth extractions are very common among the senior population. A dentist can perform some extractions during an office visit, while others may require a more delicate approach by an oral surgeon.

Another common dental surgery involves placing wiring within the mouth to help someone recover from a jaw fracture, which is considered corrective dental surgery. Restorative dental surgeries are also common as they deal with the removal of cancerous and non-cancerous tumors. Oral cancer impacts 30,000 Americans each year; restorative surgery is among the top three most common dental surgeries performed.

How Medicare covers these dental surgeries

When oral surgery is recommended and required to treat a health condition, Medicare may cover the surgery. For example, restorative dental surgery to remove a cancerous tumor will likely be covered by Medicare

Medicare may deem extraction surgery medically necessary if a diseased tooth needs to be removed before organ transplant surgery or radiation treatment. Corrective surgery may be covered if repairs need to be made to the jaw after a fracture or tumor removal.

How Medicare pays for these dental surgeries

If Medicare approves the dental surgery, Medicare Part B will cover the procedure at 80% after you meet your annual deductible. The beneficiary is responsible for 20% coinsurance. If the beneficiary is admitted as an inpatient in the hospital, he or she will also be responsible for the Part A deductible.

However, beneficiaries with Medigap plans can breathe a sigh of relief since most of them cover the Part B coinsurance and Part A deductible in full. For example, a beneficiary with a Medigap Plan G admitted for a Medicare-covered restorative dental surgery will only have to pay the Part B deductible. Plan G covers all other Medicare costs.

Routine dental services

Medicare doesn’t cover routine dental services such as cleanings, x-rays, fillings, and dentures. However, before an organ transplant, Medicare may cover a simple dental exam to ensure there aren’t any diseased or damaged teeth that need to be extracted beforehand.

Because Medicare generally doesn’t cover routine dental services, beneficiaries often wonder how to obtain dental insurance. Most Medicare Advantage plans include ancillary benefits, such as dental, vision, and hearing. These benefits may be built into the plan or may come at an additional premium.

Another option seniors have for dental insurance is a standalone dental or dental, vision, and hearing plan. These plans can be purchased anytime during the year. However, there may be waiting periods for major services. For example, a dental plan may have a 12-month waiting period for major services, such as bridges, crowns, and root canals.

One last option seniors have is negotiating cash prices with their dentist. Generally, the cash price is more cost-effective than the copay on a dental insurance plan.

Many seniors are surprised to find out that Medicare doesn’t cover most dental services. However, it may be relieving to know that Medicare will cover major dental surgeries that are medically necessary to treat specific medical conditions.

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