Is Oral Surgery Covered by Medical Insurance?

What is oral surgery?

Oral surgery refers to any surgical procedure performed on your teeth, gums, jaws, or other oral structures. It requires an invasive approach, meaning that it will access areas below the soft tissue of the gum or mouth.

Types of oral surgery include tooth extractions, dental implants, and jaw surgeries. Oral surgery is usually performed by an oral surgeon or a periodontist. Learn more about oral surgery and how to prepare if you ever need it.

What are common reasons to have oral surgery?

There are many reasons why someone may need oral surgery. Commons reasons to perform oral surgery include¹:

• Oral cancer
• Tooth loss or decay
• Wisdom teeth extraction
• Temporomandibular Joint (TMJ) pain
• Sleep apnea
• Trauma

Is oral surgery covered by medical or dental insurance?

Your dental health can affect your overall health and vice versa. When you require an important dental procedure, like oral surgery, some of the costs may be covered by both your dental insurance plan and your medical insurance plan.

There are many types of dental insurance and types of health insurance that can help cover different forms of dental work.

Whether or not your medical insurance covers a dental-related procedure will depend on your insurance provider and plan coverage. In most cases, medical insurance plans will cover certain major oral surgery procedures, like jaw surgeries.

When is oral surgery covered by medical insurance?

Medical insurance may be able to cover the cost of a medical-related oral surgery depending on your plan, medical health status, type of surgery, and difficulty of the surgery.

There are four common types of dental procedures that may be billed as medical procedures²:

Diagnostic procedures

Diagnostic procedures may be billed as a medical procedure. These procedures are used to diagnose a medical condition. Examples include medical imaging, bacterial testing, models, stents, examinations, and consultations.

Non-surgical medical procedures

If treated as a medical condition, a non-surgical procedure may be billed as a medical procedure. Examples include incisions and drainage of abscesses, emergency treatments for infection and inflammation, and TMJ.

Surgical treatments

Surgical treatments may be billed as medical procedures. Examples include soft and hard tissue biopsies, cancer-related treatments, dental implants, complicated wisdom tooth extractions, and medically necessary tooth removals.

Treatment for dental or facial trauma

Treatment for traumatic dental or facial injuries may be billed as medical procedures. Facial trauma can be complex and involve multiple treatments such as bone repair, infection prevention, and teeth replacement.

What does dental insurance cover?

Most common oral surgeries are covered, at least in part, by your dental insurance provider. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage.

Dental insurance can help cover:

• Preventive care, such as dental cleanings and routine office visits
• Restorative care, such as cavity fillings and crowns
• Oral surgery, such as tooth removal and grafts
• Orthodontics, such as braces and retainers
• Endodontics, such as root canals
• Periodontics, such as scaling and root planing
• Prosthodontics, such as dentures and bridges

What are the benefits of dental insurance?

Dental insurance makes it easier to protect your family's oral and overall health by helping you get the care you need and save money.

Some benefits of dental insurance include:

• Lower out-of-pocket costs: Dental insurance can offset dental-related costs. 
• Covered preventive care: Most dental plans fully cover routine exams, cleanings, and X-rays. 
• Covered basic and major procedures: Some dental plans cover basic restorative services like fillings and extractions, and major oral surgeries like root canals, crowns, and more. 
• Improved oral health: Regular dental exams can help identify oral issues early and prevent future dental problems. 
• Improved overall health: Good dental health can help you avoid serious health problems like heart disease and coronary artery disease.³

How much does oral surgery cost without insurance?

Some dental insurance plans are more affordable than others, such as dental HMO plans. Discount dental programs may also help you get the care you need at a reduced cost. But if neither of these options work for you, here are a few other ways you may be able to reduce costs for oral surgery if you don’t have insurance.

Dental Schools and Dental Hygiene Schools

These schools allow future dentists and dental hygienists to treat patients, earning necessary dental experience while offering reduced-cost care. Experienced, licensed professionals may provide care or oversee student work and training.

Community Health Centers

Community health centers across the U.S. offer integrated oral health to underserved populations, including those needing dental work without insurance. Community health centers may offer a broad range of services, including teeth cleanings, fillings, extractions, dentures, and mouth guards. In 2023, U.S. community health center dental programs provided 15.4 million dental visits.⁴

Faith-Based and Community Organizations

If you are uninsured, you may be able to access dental services through faith-based organizations or community organizations. You may be able to get exams, cleanings, dentures, tooth removal, and other services for a lower cost.

¹ Village Dentistry, https://www.carmelsmilesdentist.com/blog/5-reasons-you-might-need-oral-surgery/, accessed October 4, 2024

² Delta Dental, https://www.deltadental.com/us/en/protect-my-smile/dental-insurance-101/is-oral-surgery-covered-by-medical-or-dental-insurance.html, accessed October 4, 2024

³ Oral health: A window to your overall health, Mayo Clinic, March 2024, https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475

⁴ Oral Health and Primary Care Integration, U.S. Health Resources and Services Administration, August 2024, https://bphc.hrsa.gov/technical-assistance/clinical-quality-improvement/oral-health-primary-care-integration

Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company and Cigna Dental Health, Inc. In Texas, the insured dental product offered by CGLIC and CHLIC is referred to as the Cigna Dental Choice Plan and this plan utilizes the national Cigna Dental PPO Network.

This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. Any third-party content is the responsibility of such third party. Cigna Healthcare does not endorse or guarantee the accuracy of any third-party content and is not responsible for such content. Your access to and use of this content is at your sole risk.