Generally, Original Medicare (Parts A & B) does not cover removing tori (bony growths in the mouth) because it's considered dental, but coverage might be available if the procedure is a necessary part of a covered medical treatment (like organ transplant prep) or if you have a Medicare Advantage Plan (Part C) or dental insurance that includes it. The key is whether it's "inextricably linked" to a major medical procedure or falls under a separate dental benefit.
Medicare: Medicare generally provides a rebate for the medical components of corrective jaw surgery, primarily a portion of the surgeon's and anaesthetist's fees, if the surgery is for functional reasons (e.g., correcting bite problems, improving breathing, addressing TMJ issues).
While purely cosmetic surgeries are not covered by Medicare, medically necessary plastic and reconstructive surgeries often are. For surgery to qualify, it must serve a functional purpose or address significant health concerns rather than purely aesthetic improvements.
Is TMJ treatment covered by medicare? Medicare Part B covers TMJ treatment (even TMJ surgery) as long as it is performed by a qualified physician. If, however, your TMJ treatment falls into the category of pure dentistry, and not general healthcare, Medicare may not cover it.
Medicare will cover the cost of hernia repair surgery performed as a public patient in a public hospital. It will also cover some of the MBS fee of hernia operations performed in a private healthcare clinic, while an eligible hospital insurance policy can cover the rest.
Some of the items and services Medicare doesn't cover include:
What is a ventral hernia? A ventral (abdominal) hernia refers to any protrusion of intestine or other tissue through a weakness or gap in the abdominal wall. Umbilical and incisional hernias are specific types of ventral hernias.
“Do I qualify for jaw surgery?” — It's one of the most common questions people ask when dealing with persistent bite problems, jaw pain, or facial imbalance. The short answer: you may qualify if your jaw alignment affects your bite, speech, breathing, or overall function — not just your appearance.
The 3-finger test for TMJ (Temporomandibular Joint) is a simple self-assessment where you stack your index, middle, and ring fingers vertically and try to fit them between your upper and lower front teeth; comfortably fitting three fingers suggests healthy jaw opening, while difficulty fitting them, pain, or clicking indicates potential restrictions or a TMJ disorder (Trismus) that might need professional evaluation. It's a quick screening tool, not a definitive diagnosis, to check your jaw's range of motion.
No, Medicare generally does not cover orthodontics (braces, Invisalign) because it's considered elective or cosmetic, not essential medical care, but there are rare exceptions for severe medical conditions like cleft palate where public dental services or specific Medicare Benefits Schedule items (MBS) may apply, requiring consultation with specialists or public clinics for eligibility.
Does Medicare cover weight-loss surgery? Yes, Medicare covers some types of bariatric and metabolic surgery for people who meet certain conditions associated with morbid obesity — a BMI of 35 or above and other conditions, such as diabetes, high blood pressure, high cholesterol and even sleep apnea.
Inguinal Hernias are the most common surgical procedure completed in the General Surgery speciality. As such, the waiting list for surgery in public hospitals for Inguinal Hernia Repair Surgery can be up to 348 days.
Medicare does not generally cover routine foot care (RFC) services unless the enrollee has systemic medical conditions that increase the risk of infection or injury if the services are not performed by a medical nonprofessional (e.g., a podiatrist).
Jaw surgery may be offered as a treatment option when there is a big size mismatch between your upper and lower jaws, a large asymmetry, or if your jaws have grown away from each other resulting in a gap between your front teeth.
A single jaw surgery (upper or lower jaw) could cost up to $6000 to $8000. If a patient requires two jaw surgeries (bi-maxillary surgery), the cost could increase to $10000- $14000 including the maxillofacial surgeon fee, and anesthetist fee.
Medicare Australia generally does not cover routine dental services for adults, but it does cover basic dental care for eligible children through the Child Dental Benefits Schedule (CDBS), including check-ups, cleanings, fillings, and extractions up to a cap amount (around $1,000-$1,100). For adults, Medicare only steps in for complex dental treatments required as part of a major medical procedure or for specific conditions, like jaw reconstruction, and usually doesn't cover private practice dental costs.
Conditions That May Be Mistaken for TMJ Disorder
Pain and Stiffness
If your jaw feels a little stiff or sore, and it's hard to open your lower jaw wide enough to yawn, you might have a misaligned jaw. Misalignment can cause you to compensate in various ways, leading to additional aches and or chronic pain in the jaw joint.
Muscle relaxants are another medication for TMJ that are very helpful if you have muscle tension and spasms. They include brands such as Flexeril, Soma, Skelaxin, Zanaflex, Robaxin, and Baclofen and can only be obtained by prescription. Muscle relaxants are designed to be taken only for a short period of time.
Often, the optimal time for jaw surgery is after the jaw stops growing, usually in the later teenage years—typically ages 17 to 21 for boys and ages 14 to 16 for girls.
Surprisingly, jaw surgery is typically not very painful. Most patients describe it as unpleasant or uncomfortable due to swelling that is more bothersome than other areas of your body because it involves your face, mouth, and throat.
Jaw surgery is generally very safe when an experienced oral and maxillofacial surgeon does it, often planning and working with an orthodontist. Risks of surgery may include: Blood loss. Infection.
Medicare offers coverage for hernia surgery, with Part B covering 80% of the costs. A person with a Medicare Part C (Medicare Advantage) plan may also have coverage.
A ventral hernia's symptoms are determined by its location in the abdomen and can include sharp pain that may be present during physical activity, vomiting (in the case of incisional hernias), and constipation. Ventral hernias are typically diagnosed by checking the abdomen for a noticeable bulge.
Large hernias are 10cm or larger. Hernia surgery can be major (open) or minor (laparoscopic) surgery. Recovery time for hernia surgery is quicker for laparoscopic surgery compared to open surgery.