Will an Abscessed Tooth Be Covered by Medicare?
- Some Medicare Advantage (Part C) plans may cover abscessed tooth treatment. Original Medicare (Parts A and B) doesn’t typically cover routine dental care, including treatment of a tooth abscess.
While Original Medicare (Medicare Part A or Part B) doesn’t typically cover routine dental care such as treatment for a tooth abscess, some Medicare Advantage (Medicare Part C) plans may cover abscessed tooth treatment and other dental benefits.
Below is an overview of Medicare dental coverage and what you should know about how each different part of Medicare covers dental procedures, tooth extractions, cleanings, fillings and more.
Does Medicare Cover Oral Surgery?
Your inpatient hospital costs may be covered by Medicare Part A if you get oral surgery as part of preparation for other medically necessary surgery (such as jaw surgery to treat oral cancer) or to repair dental damage from a serious injury. A routine tooth abscess removal is not typically covered by Original Medicare, however.
Medicare Part B may help cover your surgery costs if your oral surgery is performed in an outpatient setting, but only if your doctor determines that the surgery is medically necessary. In order for your oral surgery to be considered medically necessary, it must be required in order to treat a specific injury, illness, disease or condition.
Original Medicare does not typically cover routine dental care. This includes dental services such as cleanings, fillings, tooth extractions and abscessed teeth.
Does Medicare Advantage Cover Tooth Infection and Other Dental Care?
92% of Medicare Advantage plans offer dental coverage in 2021.
Medicare Advantage (Medicare Part C) plans are sold by private insurance companies. These plans are required by law to provide all of the same basic coverage found in Medicare Part A and Part B. Beyond that minimum requirement, many Medicare Advantage plans may then offer additional coverage for certain things covered by Original Medicare.
Dental coverage is often an extra benefit offered by Medicare Advantage plans. In most cases, Medicare Advantage plan dental benefits will include coverage for the treatment of an abscessed tooth.
Other common Medicare Advantage plan benefits include vision hearing care and prescription drug coverage.
Medicare Advantage plans may require a monthly premium, although many plans come with $0 premiums. Deductibles, coinsurance and copayment requirements will vary by plan.
The selection of Medicare Advantage plans varies by location.
Do Medicare Part D Plans Offer Dental Coverage?
Medicare Part D plans cover prescription medications, so a Part D plan will not provide any dental benefits. However, an individual who has an abscessed tooth repaired may be prescribed antibiotics following the procedure, and the antibiotics will typically be covered by a Part D plan.
Most Medicare Advantage plans also provide coverage for prescription drugs.
Standalone Dental Plans
Another option for Medicare beneficiaries seeking dental coverage is to purchase a standalone dental insurance plan through a private health insurance carrier or the Health Insurance Marketplace. Many employer-based plans include an option for dental coverage.
Most standalone dental plans will cover abscessed tooth treatment.
How Do You Treat an Abscessed Tooth?
A tooth abscess is a pocket of pus that has accumulated under or near a tooth as a result of a bacterial infection. A tooth abscess can cause pain, sensitivity to hot or cold temperatures and chewing, fever, swelling, odor and difficulty breathing or swallowing.
If left untreated, the infection may spread to other parts of your body and can even lead to the life-threatening infection called sepsis.
The most common treatments for an abscessed tooth include:
- Draining the buildup of liquid
This is only done for a very minor abscess near the surface of the gums. While this treatment does provide pain relief, it does not address the abscess itself.
- Root canal
The most common treatment for a tooth abscess is a root canal. During a root canal, the infected tissue is accessed and removed by drilling through the center of the tooth. The resulting hole is then filled with a synthetic material.
A tooth abscess that is large or badly infected may require the dentist to extract the tooth entirely.
Antibiotics are often used in conjunction with the above treatments to help the body fight off bacteria caused by an abscess and prevents the infection from spreading.
You can help prevent a tooth abscess by practicing good oral hygiene such as brushing twice a day, drinking fluoridated water, limiting sugary foods and drinks and visiting your dentist for a checkup every six months.