November 13th 2024
By Ari Parker
Many people find it frustrating that Medicare doesn't cover dental and vision care. Learn how you can save on dental & vision services while on Medicare.
By Ari Parker
As you age, you may find that you don’t see or hear as well and have more problems with your teeth. Especially because dental, vision, and hearing issues increase as we age, many people are surprised to find that Original Medicare doesn’t provide coverage for routine vision, dental, or hearing care. After all, being able to see, hear, smile confidently, and chew your food are all important for healthy aging!
Why doesn’t Medicare cover these services? How can you get insurance to pay for all or most of the cost of dental, vision, or hearing care? Will Medicaid cover costs if your income is low enough to qualify for it?
Original Medicare is what you get when you first enroll in Medicare. It’s made up of Part A and Part B. Original Medicare doesn’t cover routine eye exams, glasses, contact lenses, dental exams, hearing tests, or hearing aids. This is because Medicare considers these exams and treatments “non essential.” It is hard to imagine that these services are not considered necessary. Most employer health plans, however, also don’t include dental and vision coverage. These tend to come as separate plans.
Since Medicare was created, only a few benefits have been added. While prescription drug coverage was added, it was chosen to be separate from Original Medicare. According to Jonathan Oberlander, a health policy professor at the University of North Carolina-Chapel Hill, Medicare’s creators assumed the program would expand covered benefits. However, Medicare has since become a financial problem, and policymakers are concerned about lack of funds for the existing benefits.
Recently, President Joe Biden proposed adding dental, vision, and hearing coverage to Medicare in his post-pandemic Build Back Better Proposal in 2022. The American Dental Association (ADA) mobilized its members to oppose the measure. Its logic was that Medicare reimbursement would be too low. This is the same thinking that was behind the American Medical Association (AMA)’s objections to Medicare nearly 60 years ago. Even today, some physicians do not accept Medicare for treatment.
Adding dental coverage to Original Medicare would cost $238 over 10 years, according to an analysis by the Congressional Budget Office.
Medicare may not cover routine dental exams, teeth cleanings, routine vision exams, or routine hearing tests, but it will cover services considered medically necessary.
Vision: While Medicare won't pay for exams or glasses, they will pay for more serious issues.
Testing for problems related to diabetes, such as diabetic retinopathy
Checking for glaucoma if you have a family history of glaucoma or other risk factors
Cataract surgery to remove the cloudy covering on your eyes and replace it with an intraocular lens
One pair of glasses or contacts after cataract surgery
Exams to determine serious eye conditions if your vision is compromised
Dental: Medicare will pay for certain dental services, such as necessary tooth extractions, oral exams before organ transplants, cardiac valve replacements, valvuloplasty procedures, or head or neck cancer. It won't pay for any aftercare.
Hearing: Medicare will pay for services from an audiologist once every 12 months for hearing loss or balance issues that have been present for 12 months or more.
Over recent decades, vision, dental, and hearing care have come to be viewed as part of maintaining our overall health. Preventative care, not just treatment, is now the norm.
Many people on Medicare want their dental, vision, and hearing services covered, and there are two ways to obtain coverage: either through a Medicare Advantage plan that includes coverage or through separate, private insurance plans.
Medicare Advantage plans provide an alternative to Original Medicare. They must cover the same services as Original Medicare (Part A and Part B) and they also usually cover Medicare Part D (prescription drug coverage). Medicare Advantage plans are increasingly popular because they can provide additional benefits, including dental, vision, and hearing coverage.
Plans vary by company and location, but when consumers compare plans, they can see what is covered.
Vision: A Medicare Advantage plan might cover routine eye exams and prescription glasses. Like with all vision insurance, insurance companies have varying coverage, including the amount they’ll cover for corrective lenses. When comparing plans and considering your preferences, it’s important to understand the differences between plans’ vision coverage.
Dental: Most Medicare Advantage plans cover routine dental services (cleanings, x-rays, exams) as well as services, like:
Fillings
Deep cleanings
Crowns and bridges
Tooth extractions
Root canals
Partial and complete dentures
IV sedation and general anesthesia
Dental implants
The catch is that plans come with maximum coverage amounts, which represent the maximum amount a plan will pay before you’re responsible for 100% of costs. This is similar to how employer plans work.
Hearing: Hearing coverage provided by Medicare Advantage plans generally include coverage for hearing exams and hearing aids. Like with corrective vision lenses, plans usually cover a maximum amount for hearing aids. Who offers Medicare Advantage plans?
Medicare Advantage plans are provided by private insurance companies, like Humana, Aetna, Blue Cross Blue Shield, and Devoted Health.
As the Medicare Open Enrollment Period (October 15-December 7) approaches each year, the major players in the field, like Mutual of Omaha, Aetna, United Healthcare, Humana, , publicize their offerings for the coming year. You can work with one of our licensed Medicare agents to find the best plan for your personal health and financial needs.
Every Medicare Advantage plan is different, so it’s important to understand a plan’s premiums, coverage, and out-of-pocket costs. Below are several factors that can affect how much you pay for your Medicare Advantage insurance and the services you receive.
Monthly premiums: What is the premium? For some Medicare Advantage plans, the monthly premium is $0.
Part B premium rebates: Your overall costs can be reduced if your plan provides a rebate for the Part B premium.
Yearly deductible: Each plan has its own annual deductible you must meet before your plan starts to pay its share of costs.
Other out-of-pocket costs What are the coinsurance amounts or copayments you pay for each service or visit?
Service coverage: What services can you access and how often are they supplied?
Doctor/supplier networks: Are your doctors in the network? Is your plan an HMO or PPO?
Extra benefits: Does the plan cover and pay for what you need? Does it cover prescription drugs, hearing services, vision care, and dental coverage? Will it pay for the drugs you take?
Yearly out-of-pocket maximum: What is the yearly maximum out-of-pocket costs for covered medical services (note: dental, vision, and hearing are often excluded)?
Medicaid: Are you dually eligible for both Medicare and Medicaid?
Medicare Supplement (Medigap) plans help cover the out-of-pocket costs that Original Medicare does not. They do not, however, provide coverage for additional services—including dental, vision, and hearing services.
There are ten Medicare Supplement plans, labeled by letters A-N. Plan G is generally considered the best because it covers all of your out-of-pocket costs aside from the Part B deductible. Some people who enroll in Original Medicare and Medicare Supplement may choose to add private dental, vision, and hearing insurance plans to their coverage. If you’re considering this, take a look at premium and benefit amounts to determine if the plan will save you money because they often don’t if you only need routine care.
If you lack dental benefits, need glasses or hearing aids, or even have prescription drug coverage that does not cover your specific drugs, there are options in the community to help.
You may find discounts and coupons to help you. Some opticians, such as Lenscrafters, offer substantial discounts on frames and lenses throughout the year that may make glasses more reasonable. Organizations such as AARP and AAA offer discounts as well.
Many organizations have programs that help needy seniors get the help they need. We’ve shared some below.
Vision
EyeCare America® offers certain eye care services for free through a nationwide network of ophthalmologists (eye doctors).
New Eyes provides low-income seniors with vouchers for prescription glasses.
Your local Lions Club chapter may have a program for severely vision-impaired individuals.
Dental
The American Dental Association website lists local dental schools offering free or discounted dental procedures.
Community health centers in your area may offer inexpensive dental care for low-income individuals.
You may qualify for free, comprehensive dental treatment in your state through the Dental Lifeline Network.
Hearing
Help America Hear new hearing aids for people with low income, based on need
Your local Lions Club may distribute low-cost hearing aids to those in need.
The National Hearing Aid Project helps connect people to national and state hearing assistance programs.
