Everyone has a third set of molars known as wisdom teeth. For most people, these special molars push through the gums at the age of 17 to 25, but for others, they either never develop, or they can cause health issues at a later age.
If a wisdom tooth doesn’t have enough room to push through the gum it can become impacted causing it to erupt partially or remain below the gum. If you have impacted wisdom teeth, your health care provider might suggest you have them extracted because they can cause the following health issues:
- Severe pain
- Infection or periodontal disease
- Tooth decay
- Damage to another tooth or bone tissue
- Problems keeping the area clean and bacteria-free
Having your wisdom teeth extracted involves a surgical procedure that a dentist or an oral surgeon performs while you’re under anesthesia. During the procedure, the surgeon cuts through the gum, removes the tooth whole or by cutting it into smaller pieces, and finishes by stitching up the gums.
If you’re experiencing pain, discomfort, or other health problems due to impacted wisdom teeth, you might need to have them removed, but does Medicare cover these procedures?
Does Original Medicare cover wisdom tooth removal?
Unfortunately, Original Medicare Parts A (hospital insurance) and B (medical insurance) don’t cover routine dental care services such as:
- Oral exams and teeth cleaning
- Oral surgery
- Wisdom tooth removal
- Dentures or dental implants
- Root canal treatments
Original Medicare Parts A and B only cover dental care services if they are a medically necessary component of another Medicare-covered medical procedure, or in the case of an emergency. For example, if you need a tooth extraction while undergoing reconstructive jaw surgery due to an accident, the extraction would be covered.
Because the removal of wisdom teeth is considered to be a cosmetic procedure rather than a medically necessary procedure, it isn’t included in Original Medicare coverage and you must pay out-of-pocket.
Do Medicare Advantage (Part C) plans cover wisdom tooth removal?
Many Medicare Advantage plans sold in the United States include extra benefit packages that cover routine dental care, hearing care, and vision care services. Your coverage for dental care depends on your individual plan, as each provider has the option to include these additional benefits along with the mandatory Part A and B benefits.
You should check your plan policy to ensure that you have coverage for your dental procedure before making an appointment, but most plans cover the following services:
- Routine checkups
- Teeth cleaning
- Tooth extraction (possibly including wisdom teeth)
- Dentures and other appliances
- Dental implants (in some instances)
Depending on the type of Medicare Advantage (MA) plan you have, you might need to use your plan’s network providers to get coverage. Many MA plans can keep costs down by having beneficiaries use specific health care providers, medical suppliers, hospitals, and other medical facilities that work with the provider. You may also need to get a referral to see a specialist like an oral surgeon from your primary care provider.
If you don’t know what health care providers you should use, call your provider for details before you make appointments.
What is the average cost of wisdom teeth removal without Medicare insurance?
Your final cost for wisdom tooth extraction depends on the complexity of your procedure and where you have it done. On average across the United States, having one impacted wisdom tooth removed typically costs between $250 and $350.