Does Medicare Cover Oral Surgery? 

Oral surgery doesn’t always involve dental procedures. Your mouth contains a number of complex tissues and connections that allow you to breathe, speak, eat and communicate non-verbally. The tissue inside of your mouth is also delicate in many ways as your gums, tongue, windpipe and top and bottom of the inside of your mouth are all susceptible to injury and disease.

For many seniors, treating injuries and illnesses inside the mouth can be handled by a dentist or family physician. In more severe cases of injury or disease inside of the mouth, oral surgery may be necessary. This can be the case when dealing with a serious condition like oral cancer, but it can also be the case after a puncture wound or laceration inside of the mouth.

Medicare benefits for oral surgery

Original Medicare coverage will cover medically-necessary surgery. This includes oral surgery that is ordered by a Medicare-participating physician. Most oral surgeries are covered by Medicare Part B, the outpatient benefit. Medicare Part B provides 80% coverage for outpatient procedures like surgery. There is no limit to the amount of coverage Medicare recipients can use in a benefit period.

In order to carry Medicare coverage through Part B, you will need to sign up for Part B during your initial enrollment period or during the Open Enrollment Period. The initial enrollment period runs from the start of the third month prior to the month you turn 65 through to the end of the third month following your 65th birthday. The Open Enrollment Period is open to all Medicare recipients who want to change their coverage options. It runs from October 15th through December 7th of each year.

Does Medicare cover dental surgery?

Because dental care and oral health are so closely related, Medicare recipients sometimes think that Medicare benefits also apply toward the cost of dental surgery. Unfortunately, Original Medicare insurance does not provide a dedicated dental care benefit, meaning dental surgeries like tooth extractions are not covered. 

Medicare Advantage plans may, however, provide coverage for dental surgery, routine dental care, vision care, hearing exams and other types of medical services that are not covered by Original Medicare benefits.

Oral surgery in a hospital

Oral surgery that is performed in a hospital will still be considered an outpatient procedure covered by Medicare Part B unless the surgery takes place as part of your care after being formally admitted. If you are admitted to a hospital or skilled nursing facility, all of the care you receive during your stay is considered inpatient care. Medicare benefits for inpatient care are supplied through Medicare Part A. 

Most Medicare recipients receive premium-free Part A, and enrollment is usually automatic upon turning 65. You can receive up to 60 days of inpatient care during a benefit period. After 60 days have been used, an additional 30 days can be covered at a discounted per-day rate. From day 91 onward, Medicare recipients have the option to use lifetime reserve days to continue receiving covered inpatient care.

Medicare and medicinal support after oral surgery

During the recovery period following oral surgery, Medicare recipients may be prescribed medications to aid in healing and rehabilitation. These prescription drugs may qualify for Medicare coverage under Part D, the prescription drug benefit.

In order to qualify for Part D coverage, all prescriptions must be available for purchase from a retail neighborhood pharmacy. Additionally, covered prescriptions need to be designated for self-administration at home and must be included in your plan’s list of covered drugs known as a formulary. Medications administered at the time of surgery are covered by Medicare Part B, and medications administered while admitted to a hospital are covered by Medicare Part A.

Part D prescription drug coverage is available in two ways. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). Alternatively, you can choose to enroll in a Medicare Advantage plan that includes prescription drug coverage (MA-PD). Part D plans are offered by private companies, so benefits and costs can vary. Compare plans carefully before enrolling. 

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