Vision and dental care are essential at all stages of life. As we age, it becomes even more critical that we receive regular checkups so we can maintain health, diagnose potential conditions before they progress, and live our best lives. But are vision and dental services covered by Medicare? This is a common question, and one that it is important to find answers to. Let’s take a look.
Are Vision and Dental Services Covered By Medicare?
Original Medicare – that is, Medicare Parts A and B – do not cover routine vision and dental care. It may cover these services if you have an underlying condition (e.g., diabetes) or if you require emergency treatment.
Medicare Parts A and B are designed to cover “medically necessary” care. This does not include:
- Dental exams
- Teeth cleanings
- Dental plates
- Routine eye exams for glasses or contacts
Now, Medicare Part A (hospital insurance) does provide some coverage if you need dental work as an inpatient. For example, if you go to the emergency room because you have severe injuries to your mouth, Part A can provide limited coverage. Or, if you need to prepare your jaw for radiation treatment, it may pay for the cost of extracting a tooth.
Likewise, if you have an object lodged in your eye or experience other trauma to the eye, Part A may provide some coverage when you go to the hospital.
Medicare Part B may cover some diagnostic or preventative vision exams, like glaucoma tests, diabetic retinopathy, or macular degeneration (if you are at higher risk). It may also cover cataract surgery. Part B may also cover glasses or lenses after such a procedure(one pair/set), as well as eye prostheses.
Again, the coverage under Medicare Parts A and B are limited and do not typically cover the routine care we all need. Does this mean you have to pay for care out of your own pocket, or worse, sacrifice checkups and treatments because you cannot afford them?
Fortunately, no. You can access Medicare Advantage plans with dental and vision. This is also known as Medicare Part C. Your Advantage plan will cover the same benefits as Parts A and B, but it can also include additional coverage.
What Do Medicare Advantage Plans With Dental and Vision Cover?
Your coverage will depend on your specific plan but you can find those that cover:
- Routine dental care (e.g., fillings, cleanings, exams, x-rays, extractions, root canals, dentures, implants, bridges, and crowns)
- Routine eye care (exams, preventative exams, glasses and contact lenses, and upgraded frames)
Other Medicare Advantage plans include coverage for prescription drugs and health/fitness program memberships.
How Do You Get a Medicare Advantage Plan – and How Much Does It Cost?
Medicare Advantage plans are provided by private insurance companies that contract with Medicare; this allows them to provide the coverage you would get in Parts A and B, as well as additional benefits. The specific benefits and coverages depend on your state. In general, there are four common types of Advantage plans:
- Health Maintenance Organization (HMO): Here, you must receive care from the providers in the plan, except if you need emergency care, out-of-area urgent care, or out-of-area dialysis.
- Preferred Provider Organization (PPO): With these plans, you pay less if you receive care from the providers in the network and more if you receive care from those outside of it.
- Private Fee-for-Service (PFFS): With PFFS, the plan determines what portion they will pay based on the service and what portion you will pay.
- Special Needs Plans (SNP): SNPs are plans for those with certain diseases or characteristics (e.g. cancer, chronic health failure, HIV/AIDS).
What are the out-of-pocket costs of a Medicare Advantage Plan? This depends on a number of factors, such as:
- Whether your plan charges a monthly premium. Some do not.
- Whether your plan pays all or part of your Medicare Part B premium.
- If you have any deductibles.
- Your copay, or how much you pay for each visit or service.
- The type of services you need and how often you need them
- Whether your plan charges for extra benefits
- Your maximum out-of-pocket costs
- Whether you have Medicaid or state aid
- Whether you use an in-network provider (if you are on a PPO or PFFS plan)
You can compare plan costs and find one that works for you at Medicare.gov. It is worth taking the time to learn about different plans and choose the one that best suits your health needs and your budget.
>> Cano Health takes pride in being Florida’s leading health care services provider for seniors with Medicare and Medicaid coverage. If you have questions regarding your care or would like to know more about Medicare Advantage plans with dental and vision services, please contact us at 855.CANOMED (855.226.6633).