Does Insurance Cover Jaw Surgery?
One of the most important financial questions about orthognathic surgery is whether insurance will help pay for it. Here is what you need to know.
Yes β many health insurance plans cover orthognathic surgery when it is deemed medically necessary. However, purely cosmetic jaw surgery is not covered.
- What qualifies as medically necessary:
- Difficulty chewing or biting
- Speech problems caused by jaw alignment
- Sleep apnea (confirmed by sleep study)
- Chronic jaw pain or TMJ dysfunction
- Difficulty swallowing
- Open bite, underbite, or overbite that affects function
- What is NOT covered:
- Surgery performed solely for cosmetic reasons
- Orthognathic surgery to improve facial appearance when there is no functional problem
- Orthodontics (braces) β these are often covered under separate dental insurance, if at all
- Typical insurance coverage:
- Surgeon fees: 50β80% covered after deductible
- Hospital fees: 50β80% covered after deductible
- Anesthesia: Usually covered
- Imaging: Usually covered
- Orthodontics: Usually NOT covered by medical insurance (may be partly covered by dental insurance)
How to Get Approved
- Get a referral from your orthodontist and/or dentist
- Have your surgeon submit pre-authorization with supporting documentation
- Include X-rays, photographs, and a letter of medical necessity
- Be prepared for the possibility of an appeal if initially denied
Clinical Guidance
Medical insurance typically covers 50β80% of the surgical cost of orthognathic surgery when it is medically necessary. Braces are usually not covered by medical insurance. Always get pre-authorization before proceeding.