Generally, Original Medicare does not cover routine dental and vision services. However, it may cover some dental and vision services as part of an inpatient (Part A) or outpatient (Part B) procedure.
In contrast, Medicare Advantage plans often have these services rolled into their plans. These plans offered by private insurers may include extended coverage for Medicare beneficiaries for things like hearing testing and aides, vision exams and glasses, and related prescriptions.
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Why Is Dental, Vision, and Hearing Care Important For Those On Medicare?
Dental and vision insurance for seniors on Medicare is critical. For example, while not all Medicare beneficiaries are seniors, people age 60 and older are especially vulnerable to Glaucoma.
Additionally, most people aged 65 and above experience untreated tooth decay, gum disease, and tooth loss and are more likely to be diagnosed with oral cancer at this age. Providing seniors with dental, vision, and hearing insurance is the only way to ensure they get affordable coverage for the preventive care and basic services they need to stay healthy.
Limitations On How Original Medicare Covers Dental and Vision Needs
Traditional Medicare only offers minimal vision, dental, and hearing benefits. While traditional Medicare is not enough to treat issues commonly affecting seniors like Glaucoma, periodontal disease, or hearing loss, it may cover some services only as part of another covered benefit, such as emergency jaw surgery through Part A or annual eye exams for beneficiaries with diabetes through Part B.
How Does Medigap Cover Dental and Vision Needs?
Medigap plans help beneficiaries pay for their portion of Medicare benefits, including out-of-pocket copays, deductibles, and coinsurance. Medigap only applies to original Medicare, and you cannot legally buy an Advantage plan with Medigap already in place. While Medigap does not offer additional dental and vision insurance for seniors on Medicare, it can help beneficiaries pay for any limited screenings or emergency services they may need.
How Does Medicare Advantage Cover Dental and Vision Needs?
Many beneficiaries seek out a Medicare Advantage plan specifically for dental and vision care. Enrollees in original Medicare can purchase Medicare Advantage from a private insurer, which typically includes extra benefits for vision, dental, and hearing services, and Part D prescription drug benefits. Common coverage includes routine and diagnostic dental care, vision services and accessories, and hearing testing and hearing aides.
While Medicare Advantage is only available to existing Medicare enrollees, insurers can set their own rates and terms for these plans. Not all plans offer extended dental, vision, and hearing benefits or are available in all areas to all members. If these benefits are a top priority, speak with a trusted agent to ensure your plan offers dental and vision coverage for seniors on Medicare.
How Much Would Vision and Dental Care Cost With Medicare?
The median number of Medicare beneficiaries paid just $60 in out-of-pocket dental and vision care costs in 2018. Remember: Original Medicare does not cover routine dental and vision care but may cover services that help keep your eyes, ears, and teeth healthy or are part of another Medicare-covered procedure, such as the following:
Benefit | How Medicare Covers It |
|---|---|
Glaucoma tests | Medicare pays 80% of approved amount, you pay remaining 20% |
Eye exams for those with diabetes | Medicare pays 80% of approved amount, you pay remaining 20% |
Macular degeneration tests and treatment | Medicare pays 80% of approved amount, you pay remaining 20% |
First-time Medicare visit to doctor, including basic vision test | 100% covered by Medicare |
Inpatient hospital stay if you need complex dental procedures | Medicare pays 100% of approved amount for Days 0-60. You must pay Part A copay rate for stays longer than 60 days. |
Hearing and balance tests, if ordered by physician | Medicare pays 80% of approved amount, you pay remaining 20% |
Annual audiologist appointment for non-acute hearing conditions | Medicare pays 80% of approved amount, you pay remaining 20% |
Annual audiologist appointment for diagnosing hearing loss that can be treated with surgically implanted hearing devices | Medicare pays 80% of approved amount, you pay remaining 20% |
Original Medicare will only cover the above benefits if the administering doctor and/or facility accept Medicare. Medicare Advantage plans must cover these same benefits and more, although terms and prices vary by plan. For example, many Medicare Advantage plans offer extended benefits for routine eye exams, dental care, hearing aids, and eyeglasses.
How to Find Affordable Dental, Vision, and Hearing Insurance
Private insurers offer standalone dental, vision, and hearing insurance for seniors who may not need or cannot afford Medicare Advantage. These plans offer piecemeal enrollment for Medicare beneficiaries who may need only individual dental, vision, or hearing coverage, often at discounted rates or as pre-funded savings plans. Affordable standalone plans can help seniors on Medicare pay for only the vision, hearing, or dental coverage they need.
Dental Insurance for Seniors
Seniors can choose from various options for dental coverage, including buying a dental plan from a private insurer or a Medicare Advantage plan with dental benefits. The following are among the most common options:
- Traditional dental insurance: Seniors can always purchase a standalone dental plan regardless of their Medicare benefits. These plans typically cover all routine and non-routine dental services but may be limited to in-network dentists. Services may incur a set fee or require coinsurance payments. Many dental plans offer $0 deductibles and immediate enactment of benefits.
- Discount dental plans: Discount dental plans offer major services at a preset rate through a network of contracted dentists. Since the insurer and the in-network dentists agree upon the discounted rates in advance, policyholders simply pay that fee for each procedure without needing to submit a claim. Purchasing a discount dental plan separately does not affect Medicare benefits.
- Dental savings plans: Dental savings plans are membership-based plans similar to discount plans. Members can add funds to their savings plan to be used for dental care throughout the year without the hassle of copays, deductibles, or premium payments. Dental savings plans can be purchased separately from Medicare and used as needed.
- Medicare Advantage plans with dental benefits: Medicare beneficiaries may purchase a Medicare Advantage plan that includes dental benefits instead of a standalone dental plan. While rates may vary by insurer and plan, this coverage also includes vision and hearing benefits as a bonus for seniors seeking “extra” services.
Vision Insurance for Seniors
Many seniors also require vision insurance beyond what traditional Medicare offers. The following traditional, discounted, and extended coverage is available:
- Traditional vision insurance: Seniors may purchase a standalone vision plan to use alongside their Medicare benefits. Each plan requires its own premiums and copays/coinsurance, depending on the insurer. Benefits usually go into effect immediately upon enrollment. Many plans do not require a deductible.
- Discount vision plans: These plans typically work with a specific network of optometrists and ophthalmologists to provide services for a set fee, often lower than a traditional vision insurance policy. Seniors must “join” discount vision plans as members though these policies operate similarly to traditional vision insurance.
- Vision savings plans: Vision savings plans offer members the opportunity to pay into an “account” with a particular vision insurance provider and use the funds for vision care. Like a discount plan, a vision savings plan may offer set prices for standard services and typically does not require copays, premiums, or deductibles. Vision savings plans must be purchased separately.
- Medicare Advantage plans with vision benefits: Most Medicare Advantage plans include vision, dental, and hearing benefits as the primary reason beneficiaries enroll. While you may get the one-time vision coverage you need under select circumstances with original Medicare, acute vision care typically requires Medicare Advantage.
Audiology Insurance for Seniors
Standalone audiology insurance options may not occur as commonly as vision and dental insurance, but you can still find help to pay for hearing coverage with state-funded Medicaid insurance. Seniors with Medicaid may get coverage for routine hearing screenings. Medicare beneficiaries should explore Medicaid benefits in their state if they require regular visits with an audiologist.
In some cases, Medicare Part B covers specific hearing tests if ordered by your doctor. Original Medicare may also cover routine outpatient services, including audiology screenings for non-acute conditions and diagnostics leading to surgical cochlear implant recommendations.
Seniors should purchase a Medicare Advantage plan if they require additional substantial hearing insurance benefits. While plans vary, most Medicare Advantage plans offer benefits, including at least one annual hearing exam, fittings for hearing aides, and 1-2 hearing aides per year.
What to Look For When Comparing Your Dental and Vision Insurance Options
Dental and vision insurance for seniors on Medicare varies per individual. Consider the following criteria to decide whether a standalone or Medicare Advantage plan is right for your needs:
- Coverage: Make sure any prospective insurance plan would cover the basic services you need, such as routine eye exams, eyeglasses, or glaucoma screenings. Also, consider how a plan’s coverage limits, waiting periods, and exclusions may affect the specific benefits you need.
- Costs: Look at a plan’s premiums, deductibles, and copays to get an idea of the overall cost of coverage. Determine your budget for dental and vision insurance and compare rates. Affordable options exist for even the most comprehensive dental and vision benefits, including discounted and $0 deductible plans.
- Network: Check to see if the plan maintains its own network of eye doctors or dentists, and make sure in-network or approved facilities exist in your area. If not, consider how willing you might be to switch from your existing provider to a different doctor. Remember: some plans offer limited options and only cover in-network services.
- Reputation: Check the plan’s reputation and financial stability, and consider whether the company has a history of providing high-quality coverage and customer service. Medicare rates its Advantage plans using a star rating system to help consumers compare plans. Standalone vision and dental plans should offer independent customer ratings and reviews.
What This Means For You
The high out-of-pocket costs of dental, vision, and hearing benefits do not make seniors’ needs for these benefits any less crucial. Unfortunately, many go without the care they need due to a lack of awareness about affordable dental and vision insurance options for seniors on Medicare.
Unlike original Medicare, Medicare Advantage plans may offer routine benefits to help you stay healthy and avoid common age-related vision, dental, and hearing conditions. You may also consider buying a standalone plan for one or more of these benefits.
If you think you may need vision, dental, or audiology services in the near future, make sure to conduct a thorough research about the best option for your situation or speak with a trusted insurance agent.