Does Medicare Cover Tooth Extraction by an Oral Surgeon?
Navigate Medicare's coverage for tooth extractions. Learn about specific medical necessity exceptions and explore other dental plan options.
Medicare, a federal health insurance program, generally provides coverage for individuals aged 65 or older, and certain younger individuals with disabilities. Many people inquire about Medicare’s coverage of dental care, particularly for tooth extractions performed by an oral surgeon. Original Medicare has specific rules regarding dental services and does not cover routine dental care.
Original Medicare’s Stance on Dental Care
Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), does not cover routine dental services. This exclusion applies to common procedures such as cleanings, fillings, dentures, and most tooth extractions. The program is designed to cover medical care, not services focused on the health of teeth or their supporting structures. Beneficiaries are responsible for the full cost of these routine dental services out-of-pocket.
This policy broadly excludes services related to the care, treatment, filling, removal, or replacement of teeth. Therefore, if a tooth extraction is performed solely for dental health purposes, Original Medicare will not cover it. This means individuals needing typical tooth removals, including wisdom teeth, often need to seek alternative coverage or pay for these procedures themselves.
Specific Situations Where Coverage May Apply
Despite the general exclusion, Original Medicare may cover a tooth extraction if it is medically necessary and integral to a larger covered medical procedure. This applies when the dental service is required to ensure the success of another Medicare-covered treatment or to address a medical condition. For instance, Medicare Part A might cover dental services if a beneficiary requires hospitalization due to an underlying medical condition or the severity of the dental procedure. This can include the hospital costs associated with the stay, even if the dental procedure itself is not covered.
Medicare Part B may also cover certain outpatient oral surgeries if they are medically necessary. Examples include tooth extractions performed before radiation treatment for jaw cancer to reduce the risk of complications. Coverage may also extend to dental examinations and treatments to eliminate oral infections prior to major medical procedures like organ transplants, including kidney or heart valve replacements. Surgical repair of a jaw fracture or reconstructive surgery following the removal of a facial tumor may also include related dental services. For covered services, beneficiaries pay 20% of the Medicare-approved amount after meeting the Part B deductible, which was $257 in 2025.
Medicare Advantage and Other Dental Coverage Options
Given the limited dental coverage under Original Medicare, many beneficiaries explore alternative options for more comprehensive dental care. Medicare Advantage Plans, also known as Part C, are offered by private insurance companies approved by Medicare and often include additional benefits not covered by Original Medicare. These plans can provide dental coverage ranging from basic preventive care, such as cleanings and exams, to more extensive services like fillings, root canals, and extractions. The specific dental benefits, including coverage for extractions, can vary significantly between different Medicare Advantage plans.
Beneficiaries should review the details of each Medicare Advantage plan to understand its dental benefits, including any limitations, network requirements, or annual caps on coverage. Some plans might require an additional monthly premium for more comprehensive dental benefits. Another option for broader dental coverage is to purchase a standalone dental insurance plan from a private insurer. These plans can cover a wide range of services, from preventive care to major restorative procedures, and can be purchased separately to supplement Original Medicare.