Does Medicare Cover Tooth Extraction?

Understanding Medicare’s Dental Coverage

Medicare is a federal health insurance program that primarily covers medical expenses for individuals aged 65 and older, as well as some younger individuals with disabilities. However, when it comes to dental care, Medicare coverage is extremely limited.

Does Medicare Cover Dental Extractions?

In most cases, Original Medicare (Part A and Part B) does not cover routine dental procedures, including tooth extractions. This means that if you need a tooth removed due to decay, infection, or overcrowding, you will likely have to pay out-of-pocket unless you have additional dental insurance.

However, Medicare may cover tooth extraction if it is medically necessary as part of a broader health treatment. Examples include:

• If an infected tooth needs to be removed before a major surgery, such as a heart transplant or radiation therapy.
• When a broken or diseased tooth is causing a severe infection that could spread and affect overall health.
• If a tooth extraction is part of a jaw-related condition or is medically required for reconstructive surgery.

In these cases, Medicare Part A may cover the hospitalization costs, while Medicare Part B may cover related medical procedures, but not the actual tooth extraction itself.

What Are the 6 Things Medicare Doesn’t Cover?

Medicare has several exclusions when it comes to routine healthcare services. Some of the key things Medicare does not cover include:

1. Routine dental care – Including cleanings, fillings, tooth extractions, and dentures.
2. Hearing aids – Medicare does not cover hearing exams or hearing aids.
3. Vision care – Routine eye exams, eyeglasses, or contact lenses are not covered.
4. Long-term care – Nursing home and custodial care are not covered unless medically necessary.
5. Cosmetic procedures – Elective surgeries for appearance enhancement are excluded.
6. Prescription drugs – Original Medicare does not cover most prescription medications unless enrolled in a Medicare Part D plan.

Is Tooth Extraction Covered Under Medical or Dental Insurance?

Tooth extractions are generally considered a dental procedure and are covered under dental insurance rather than medical insurance. However, if the extraction is medically necessary due to a health condition, Medicare may cover certain hospital-related costs but not the extraction itself.

Some Medicare Advantage (Part C) plans offer dental coverage, including tooth extractions, exams, and cleanings. These plans are offered by private insurers and vary in benefits, so it’s important to check individual policy details.

What Is the Average Cost for a Tooth Extraction Without Insurance?

The cost of a tooth extraction without insurance depends on factors such as the complexity of the extraction, the location, and the dentist’s fees. Below are the average costs:

• Simple tooth extraction: $75 – $300 per tooth.
• Surgical tooth extraction: $200 – $600 per tooth.
• Impacted wisdom tooth extraction: $300 – $1,000 per tooth.

Additional costs may include X-rays, anesthesia, and follow-up care, which can increase the total expense.

How to Get Dental Coverage for Tooth Extractions?

Since Medicare does not typically cover dental extractions, consider these alternatives:

1. Medicare Advantage (Part C) Plans – Some plans include dental coverage.
2. Standalone Dental Insurance – Private dental insurance can help cover extractions.
3. Dental Discount Plans – These plans offer discounted rates at participating dentists.
4. Medicaid – If you qualify, Medicaid may offer dental benefits.
5. Payment Plans & Financing – Many dental offices offer flexible payment options.

Final Thoughts

While Original Medicare does not cover routine tooth extractions, there are options to help manage dental costs. If you need an extraction for a medical reason, some Medicare benefits may apply. To ensure coverage, consider Medicare Advantage plans or standalone dental insurance for better protection against high out-of-pocket expenses.

If you’re searching for a Medicare plan that includes dental coverage, consult a licensed Medicare specialist to explore your options.