Ready To Find Out More About Coverage For Oral Surgery With Medicare
If you have questions about your insurance coverage, we encourage you to contact Orange County Center. Our dentist in Lake Forest is always available to answer any questions you have and can help point you in the right direction. We accept many insurance plans and always work with our patients to ensure they can receive the dental care they need.
To schedule an appointment, or to speak to one of our team members, contact Orange County Center and we will be happy to assist you.
Is Oral Surgery A Medical Or Dental Expense
The short answer to this question is that yes, medical insurance will cover some types of oral surgeries, but not all of them. In most cases, the two plans will overlap one another, picking up various aspects of the line-item expenses and expecting the other policy to pay for the ones that are not covered.
Which Dental Services Do Medicare Advantage Plans Cover
Private insurers provide Medicare Advantage plans. That means your Medicare costs may vary depending on the plan you chooseand so could your dental coverage. Some plans don’t include dental at all or require you to pay an additional premium to add this coverage. Medicare Advantage plans that do include dental services typically offer either preventative or comprehensive dental.
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Original Medicares Part A Dental Coverage
Under Original Medicare Part A, participants may be covered for certain dental services received while in the hospital. These include any emergency or complicated dental procedures deemed necessary at the time, according to Medicare.gov.
The Centers for Medicare and Medicaid Services explains that while blanket dental exclusions for Part A coverage are made under Section 1862 of the Social Security Actan act that hasnt been amended since 1980, according to the CMSone example of an emergency or complicated procedure that is often at least partially covered is jaw reconstruction needed as a result of an accidental injury.
Another instance in which Medicare Part A would pick up a portion of a typical dental care cost is if an extraction is needed to prepare a patient for radiation treatments as a result of jaw-related neoplastic diseases. Healthline says that this category of conditions are diseases involving the growth of tumors, both cancerous and noncancerous in nature.
According to the CMS, Medicare will also contribute toward oral examinations needed before kidney transplants or heart valve replacements in certain situations. Specifically, this type of expense would likely be covered under Medicare Part A if the hospitals dental staff performs the exam.
What Does Medicare Cover For Dental Care
Some Medicare Advantage plans may offer additional benefits for dental care, including services related to dental implants. Medicare Advantage plans are offered by private Medicare-approved insurance companies, so they are able to include supplemental benefits not available under Original Medicare. For example, many Medicare Advantage plans include coverage for routine dental care such as annual exams and cleanings.
Some Medicare Advantage plans even offer supplement dental insurance with coverage for more complex dental procedures such as extractions, fillings, and other types of tooth replacement or restoration, which may include dental implants. You may have to get your dental care from a network provider, and your plan may only pay a set amount for these additional services, regardless of the actual charge. There may be a separate monthly premium for supplemental dental insurance with your Medicare Advantage plan.
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Does Medicare Cover Dental
The prevalent belief is that only oral injuries, complicated or emergency procedures requiring hospital stays, and pre-transplant dental exams are covered by standard Medicare. Indeed, Medicare dental does not cover many of the routine services such as teeth cleaning, routine evaluations and X-rays, fillings, and teeth extractions. However, we have found that certain procedures deemed necessary to improve quality of life can often be included through the Part B program of Medicare dental coverage. These procedures are often some of the most expensive procedures, therefore the potential for coverage through Medicare dental is an important factor to consider.
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Oral Surgery Covered By Original Medicare
Original Medicare Medicare Part A and Part B does not cover routine dental care, but it does help cover oral surgery in certain cases.
Medicare Part A hospital insurance helps cover emergency or complicated dental services if you are a hospital inpatient. Medicare Part B medical insurance applies when you receive services in an outpatient setting.
Examples of When Original Medicare Will Cover Oral Surgery-Related Expenses
- Reconstruction of your jaw following an accident
- Tooth extractions necessary for radiation treatment of neoplastic diseases in the jaw
- Certain oral examinations but not oral treatment prior to kidney transplant or heart valve replacement surgery in some cases
Medicare will also cover the cost of hospitalization if you have to have a tooth extracted in a hospital. This can happen if you have a serious heart or other condition that makes it safer for you to have the procedure in a hospital.
In those cases, Medicare will cover the hospitalization, but you will be responsible for the full cost of the dental procedure.
Medicare determines whether it will cover oral surgery or similar procedures based on the type of service provided and the anatomical structure such as the jaw on which the procedure is performed.
Medicare does not determine coverage based on the cost, value or need for the procedure.
Does Medicare Cover Dentures
Though there may be some rare exceptions, Medicare does not typically cover dentures. However, there is some good news for patients who already have dentures that they are not entirely satisfied with. One of the most common procedures we perform at our dental clinic for our Medicare patients is dental implants. If you are a Medicare patient looking to transition from dentures to dental implants, or if you are missing multiple consecutive teeth, there is a good chance that you are eligible for Medicare dental through Medicare Part B. We can provide you with an evaluation to help determine your eligibility for coverage and start you out on your journey toward a brighter smile and healthy eating!
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What If I Dont Have Dental Coverage
If you have Original Medicare and want dental coverage, you can switch to Medicare Advantage during Medicare Open enrollment October 15 through December 7 each year. Or, if your state offers innovative Medigap plans with dental coverage, you could add a Medicare Supplement plan to your current coverage.
If you have a Medicare Advantage plan that doesnt include dental coverage, you also have options. You can change plans during the fall open enrollment period or use the Medicare Advantage Open Enrollment period . If youre new to Medicare, learn more about Medicare eligibility.
Finally, if youre eligible, your states Medicaid program may cover your dental services. Make sure you understand the difference between Medicare and Medicaid.
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When Does Medicare Cover Oral Surgery
Currently, dental coverage under Original Medicare is unfortunately quite limited, but there are some scenarios where certain dental procedures may be covered under your Original Medicare plan.
For example, certain forms of reconstructive dental or oral surgery may be covered under Original Medicare if they are considered to be medically necessary as a result of a traumatic injury.
Additionally, dental services that are considered to be medically necessary prior to another Medicare-covered procedure, such as doctor-ordered tooth extraction prior to heart surgery, will usually be covered. Likewise, a person with oral cancer may receive coverage for a dental procedure that is considered to be medically necessary prior to radiation treatment.
Medicare And A Lack Of Dental Coverage
Unfortunately, having Medicare doesnt always help with this issue. According to Medicare.gov, this federal health insurance program typically does not cover dental care, procedures, or supplies.
Medicare doesnt provide benefits toward regular cleanings or services designed to treat and/or correct problematic oral issues, such as fillings or tooth extractions.
Medicare also does not generally offer benefits for dental devices, including dentures and dental plates.
So, what does Medicare cover when it comes to dental health care?
Medicare will also contribute toward oral examinations needed before kidney transplants or heart valve replacements in certain situations.
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Is Oral Surgery Covered Under Health Or Dental Insurance
- While oral surgery is considered a dental issue, there are cases when it can become medically necessary and is covered under the terms of your health insurance policy
- If oral surgery is viewed to medically necessary in your situation, it is very likely that your health insurance will provide some type benefit to aid in paying for the procedure
- To get paid for a claim submitted because of oral surgery, you must be able to medically justify it with proper documentation
Since a dentist typically performs oral surgery, it is common to look to dental insurance to cover many of the costs associated with it. The problem with this is that dental insurance is not a mandatory form of coverage under the Affordable Care Act.
Because of this, many Americans are currently without coverage. For those that do happen to have dental insurance, they are often disappointed to find out how much they would need to pay out of pocket for major procedures such as oral surgery.
This is why such a procedure may be covered under your health insurance policy as long as it is considered to be a medical necessity. Routine cleanings and most types of dental procedures are not covered health insurance. These are often paid for out-of-pocket or covered under a dental insurance policy.
Find health insurance to cover your oral surgery by comparing free quotes. Enter your zip code above to get started.
Medicare And Oral Surgery
Dental health includes advanced procedures as well as routine care such as cleaning and X-rays that can help in the diagnosis of the underlying medical issues. In such cases, the patient may need oral surgery to correct the problem.
When the routine dental check-up reveals a more serious condition that needs oral surgery, the dentist may refer you to an oral surgeon. The common oral surgeries include tooth extraction, dental implants, corrective jaw surgeries, and biopsies. The Medicare coverage for these procedures depends on the rules and the types of oral surgery as given below:
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Legislative Help On The Way
The bipartisan Action for Dental Health Act of 2018 has been applauded by consumer advocates and the dental industry as a step towards improving Americans oral health via a grant-based program, but its also controversial in that much of its focus is on improving education and awareness surrounding oral health, as opposed to actually increasing access to care .
And high-quality dental insurance for adults remains elusive. Bills are routinely introduced in Congress to add dental care to Medicares list of covered services, but have thus far not been successful.
Most recently, Senator Ben Cardin introduced the Medicare Dental Benefit Act of 2021 . The legislation, which Cardin has introduced several years in a row, calls for Medicare Part B to cover services that are necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions. These would include things like cleanings, exams, x-rays, fillings, extractions, root canals, crowns, dentures, emergency dental care, and other necessary services related to dental and oral health.
S.97 has not advanced in the 2021 session, but you can contact your elected representatives to urge them to support this legislation if dental coverage for Medicare beneficiaries is important to you.
Original Medicare Dental Coverage
Original Medicare, Part A and B, does not cover routine dental care, including:
- Cleanings and oral exams
- Bridges
- Dental appliances, including dentures or dental plates
There are a few exceptions to this. Medicare Part A may cover certain dental services performed in a hospital if its a necessary part of a covered service. For example, if you need a preliminary oral examination before a surgery or organ transplant or if you need reconstructive jaw surgery, you may be covered for these dental procedures because the care is related to another service that Medicare does cover. You may also be covered for extractions if theyre needed to prepare your mouth for radiation for oral cancer. If you receive these services as an outpatient, youd be covered under Part B.
If you need inpatient emergency hospital care because of a complication from a dental procedure, Part A will cover your inpatient hospital treatment, even if the dental services arent covered.
Keep in mind that even if Original Medicare covers a specific dental service, you may not be covered for post-treatment dental services once the specific issue has been treated. So, for example, in the case of Medicare covering reconstructive jaw surgery, it may not continue paying for dental care after that operation.
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What Are Dental Implants
According to the Mayo Clinic, dental implants are artificial teeth attached to a metal post or screw implanted in your jawbone, which serves to replace a tooths roots. Dental implants can be an alternative to dentures or help repair broken or missing teeth where bridge work isnt possible.
There are several steps in the dental implant process, which is usually done on an outpatient basis and may take several months to complete. Your dentist may remove damaged teeth, if necessary, and prepare the jawbone to receive the implant. Then the dentist will implant the metal screw or post in your jawbone below the gum line. Once the bone has healed completely, your doctor attaches the replacement tooth to the implanted post.
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What Dental Care Is Not Covered By Medicare
Original Medicare Parts A and B do not cover dental care or oral surgery performed primarily for tooth health. Care not covered includes:
- Oral exams
- Tooth extractions
- Dentures
- Dental plates
- Other dental devices such as crowns, bridges and implants
Medicare will not cover oral surgery that is intended to treat teeth, such as installing bridges, crowns or dentures. If you dont have additional dental insurance or Part C coverage, you will pay entirely out-of-pocket for non-covered services.
Its important to note that even if your oral surgery or dental procedure is covered, Medicare will likely not pay for follow-up dental care after the health condition has been treated.
