Is Jaw Surgery Covered by Medicare or Medicaid?
Public insurance coverage for orthognathic surgery varies. Here is what you need to know.
Coverage for orthognathic surgery under government insurance programs is limited and varies by plan and location.
- Medicare (for 65+ or disabled):
- Medicare does NOT typically cover orthognathic surgery
- There are exceptions for reconstructive surgery after trauma or tumor removal
- Treatment for sleep apnea (MMA) may be covered in some cases
- Medicare does not cover orthodontics
- Check with your specific Medicare Advantage plan, as some offer additional coverage
- Medicaid:
- Coverage varies by state
- Some states cover orthognathic surgery for adults if medically necessary
- Many states only cover surgery for children under 21
- Requires pre-authorization with strong documentation
- Coverage for braces is even more limited
- How to check:
- Contact your state's Medicaid office
- Ask your surgeon if they accept Medicaid
- Have your surgeon submit a pre-authorization request
- Be prepared for a potential appeal
Alternatives for Uninsured or Underinsured
- Dental school residency programs (reduced cost)
- Sliding fee clinics
- Charitable organizations
- Medical tourism (out-of-country options, though risky)
- CareCredit or private financing
Clinical Guidance
Medicare generally does not cover orthognathic surgery. Medicaid coverage varies by state and is often limited to children. If you have public insurance, check your specific plan and be prepared to advocate strongly for coverage if you believe surgery is medically necessary.