Does Medicare Cover Oral Cancer?

Steven Mott by Steven Mott | Licensed since 2012
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This article was updated on: 10/06/2018

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About 50,000 Americans are diagnosed with oral cancer every year, reports the Oral Cancer Foundation. Around half of them survive for five years or longer. Because people might not have regular oral cancer screenings, this cancer is often detected late and at a more dangerous stage.

Here is an overview on oral cancer, including signs and symptoms, risk factors, and how Medicare covers oral cancer treatment.

What is oral cancer?

According to the Mayo Clinic, oral cancer occurs when cancer forms in the mouth, which may include the lips, tongue, gums, or inner cheeks. A type of oral cancer called oropharyngeal cancer starts in the throat, just behind the mouth, according to the American Cancer Society.

According to the U.S. National Library of Medicine (NLM), oral cancer signs may include:

  • A mouth sore that persists and won’t heal
  • Bleeding
  • A lump or growth in your mouth
  • Loose teeth
  • Difficulty chewing

This may not be a complete list of symptoms.

What are risk factors and causes of oral cancer?

Oral cancer occurs when mutations occur in the cells in your mouth and lips, according to the Mayo Clinic. In other words, it’s when abnormal cells grow out of control, explains the National Cancer Institute. However, the medical community isn’t sure what causes these mutations to start and eventually develop into oral cancer.

Oral cancer risk factors may include having a weaker immune system or having human papillomavirus (HPV). The Mayo Clinic states that there may be ways to lower your risk of oral cancer:

  • Quit smoking or chewing tobacco, since tobacco contains harmful chemicals that can cause cancer.
  • Go to the dentist regularly for routine exams, which may help detect oral cancer early.
  • Stay in the shade and wear a lip product with UV protection when going outside, since excessive sun exposure may cause oral cancer.
  • Eat a wide range of fruits and vegetables.
  • Drink less alcohol, since heavy alcohol use can make your mouth cells susceptible to cancer. 

What are some oral cancer treatment options?

According to the National Cancer Institute, there isn’t a standard oral cancer screening. However, your dentist or doctor can screen you for oral cancer during a routine dental exam or physical exam.

According to the Mayo Clinic, oral cancer treatment may vary depending on how advanced the cancer is and where it’s located. Oral cancer treatment may include surgery, radiation, chemotherapy, or targeted drug therapy, where medications attack cancer cells and might help stop them from growing.

Does Medicare cover oral cancer treatment?

Original Medicare, Part A and Part B, doesn’t generally cover routine dental services like cleanings and exams, which may detect or diagnose oral cancer. However, some Medicare Advantage plans may cover routine dental care as an additional benefit. Medicare Advantage (Part C) is an alternative way to get your Original Medicare coverage (except for hospice care, which Part A covers).

While Medicare Part B generally doesn’t cover an oral cancer screening specifically, it does cover a wide range of preventive services, including an annual wellness physical exam. Part B may also covers alcohol misuse counseling and tobacco cessation counseling. According to the National Cancer Institute, excessive alcohol and tobacco use of any kind can increase your risk of getting oral cancer.

Part B may cover doctor visits, physical exams, lab and biopsy tests, and imaging tests that your doctor orders to diagnose oral cancer. Part B also generally covers medically necessary surgeries and treatment that you get in an outpatient setting, such as radiation or chemotherapy medications. If your oral cancer requires hospitalization care, Medicare Part A usually covers inpatient hospital care. Part A and/or Part B deductibles, coinsurance and/or copayments may apply.

If you have Original Medicare, you might also consider enrolling in a Medicare Supplement (Medigap) plan, which may help with out-of-pocket expenses related to your oral cancer treatment. This may include Medicare Part A and/or Part B copayments, coinsurance, deductibles, and blood during a hospital stay.

If you or a loved one has oral cancer, you may have questions about finding Medicare coverage that could help with out-of-pocket costs. I can show you plan options, if you’d like. Just click on the link below to schedule a time to speak over the phone, or use the link next to it to request an email with plan information. To browse at your own convenience, use the Compare Plans button to get started.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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