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For many Americans, dental and vision insurance are benefits commonly provided to workers by their employers. Once those workers approach age 65 and begin applying for Medicare coverage, they need to be aware that their dental and vision coverage may not be what they were used to under an employer-provided insurance plan.
With Original Medicare, also known as Medicare Parts A and B, enrollees receive coverage on select dental and vision treatments and tests. While Original Medicare provides an acceptable amount of coverage for many people’s health care needs, it may not be enough. However, there are ways to improve your Original Medicare coverage to obtain dental and vision coverage you need.
Under Original Medicare, most of the routine dental care procedures are not covered. This means you’ll be responsible for paying 100 percent of the cost when you need a non-emergency procedure. Below are some of the dental services not included under Original Medicare:
Fortunately, some dental services are covered under Original Medicare. Medicare Part A (Hospital Insurance) provides some coverage if your dental needs require a hospital visit. For example, if you sustained significant mouth injuries and required emergency care at a hospital, then Medicare Part A might provide limited coverage.
With Original Medicare not offering coverage for routine dental exams, it can be tempting to skip your regular checkups. However, that choice can be a bad idea as these appointments can catch conditions that may become more painful and expensive over time if left untreated.
Without dental insurance, the cost of standard teeth cleaning by a dental hygienist can cost between $75-$200, depending on the dentist’s office and local rates. Since many teeth cleaning appointments also include X-rays and an exam from a dentist, the cost can jump up to $100 and surpass $300.1
To avoid paying 100 percent of dental service costs, some seniors age 65 and older elect to purchase a Medicare Advantage plan that includes dental coverage. Medicare Advantage, commonly known as Medicare Part C, replaces Medicare Parts A and B by consolidating both parts into one policy. Medicare Part C plans are Medicare-approved private health insurance plans that provide at least the same amount of coverage as Original Medicare with a max out of pocket protection. In addition to dental coverage, many Medicare Part C plans include coverage for vision, hearing orthopedic care, and wellness programs. It’s important to note that not all Part C plans include dental.
Under a Medicare Part C plan with dental coverage, your policy may be able to cover the following dental services:
Under Medicare Parts A and B, navigating vision coverage can be challenging because some services are covered while others are not. Original Medicare does not cover routine eye exams, also known as eye refractions, for eyeglasses or contact lenses. This lack of coverage means you’ll be responsible for paying 100 percent of the cost.
If you suffer from an eye condition or injury that requires admittance to a hospital, then Medicare Part A may cover your stay. Also, Medicare Part B (Medical Insurance) will cover some preventative or diagnostic eye exams.2 These preventative treatments may include:
Yearly eye exams for diabetic retinopathy, which can cause vision loss for people with diabetes
Yearly tests for glaucoma
Some tests and treatments for macular degeneration
Some aspects of cataract surgery
With a Medicare Part C insurance plan provided by a private insurance company, you may be able to fill the gaps in your health care plan. Part C plans offer the same benefits of Parts A and B, but you’ll also gain the routine eye care coverage missing from Original Medicare. Your Medicare Advantage plan provides coverage for:
Routine eye exams
Eyeglass lenses and frames
Regarding vision coverage, signing up for a Medicare Part C plan becomes an enticing option when factoring how many people need vision correction with glasses, contacts, or medical treatments. In 2015, more than 12 million Americans over the age of 40 had vision and eye problems, and that number is expected to double by 2050.3
Medicare is a powerful, but complex, system with a variety of coverage options. Our licensed agents specialize in everything Medicare. That means they can help you determine what combination of coverage is right for you.
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