How to Find Dental & Vision Coverage Under Medicare
Does Medicare have a dental and vision plan? You may be surprised to learn that the answer is no.
Original Medicare does not provide dental, vision or hearing coverage. Medicare supplemental insurance, or Medigap, generally does not offer this coverage in any of its 10 standardized plans, either.
If individuals want complete coverage for dental and vision services, they have two choices: Enroll in Original Medicare, and purchase additional policies for medical and dental coverage. Or sign up for a private Medicare Advantage plan that includes these services.
The good news is that there are different options they can explore within those confines. You may even be able to get certain services without having to switch to a private plan.
What If you Have Original Medicare?
Although it’s true that Original Medicare doesn’t cover routine vision, dental or hearing services, certain conditions and emergencies may warrant coverage under Part A (hospital coverage) or Part B (medical coverage).
Vision care — what’s not covered:
• Routine eye exams
• Standard corrective lenses
• LASIK surgery
Vision care — what is covered:
• Cataracts: Medicare does cover for charges related to diagnosing and treating cataracts, including cataract surgery if it’s done using traditional surgical techniques or lasers. (This does not include LASIK surgery.) You will have to pay the Part A deductible if your surgery requires a hospital stay. You will also need to pay your Part B deductible, plus 20% coinsurance for covered outpatient services.
Even though Medicare generally doesn’t cover eyeglasses or contact lenses, Medicare Part B will help pay for corrective lenses if you have cataract surgery to implant an intraocular lens. This would include one pair of eyeglasses with standard frames, or one set of contact lenses. The glasses or lenses must come from a supplier enrolled in Medicare.
• Diabetic retinopathy: If you have diabetes, Part B covers one exam a year for diabetic retinopathy, as long as it’s performed by a doctor licensed to perform the exam in your state.
• Eye injuries: Medicare will pay for diagnostic eye exams and tests to determine the extent of an eye injury.
• Glaucoma tests: Part B covers one annual glaucoma exam by a licensed eye doctor if you have one or more of the following risk factors:
• Diabetes
• Family history of glaucoma
• You are African-American and age 50 or older
• You are Hispanic and age 65 or older
You will pay 20% of the Medicare-approved amount for these services, plus your Part D deductible. You will also pay a copayment if your treatment requires a hospital stay.
• Macular degeneration: Medicare Part B may cover certain diagnostic tests and related doctor visits if you have age-related macular degeneration. It also covers certain treatments, including injectable drugs. Part B will cover these charges at 80% after you meet your deductible.
Dental care — what’s not covered:
• Routine dental exams
• Cleanings
• Fillings
• Crowns
• Extractions
• Bridges
• Dentures
Dental care — what is covered:
• Emergency dental procedures: Medicare Part A can pay for inpatient hospital care if you need emergency or complicated dental procedures.
Hearing services — what’s not covered:
• Hearing aids
• Exams for fitting hearing aids
Hearing services — what is covered:
• Hearing and balance exams: Medicare Part B covers diagnostic exams if your doctor orders them to see if you need medical treatment.
If you have a supplement to Original Medicare
Supplemental “Medigap” policies can be useful for paying your share of a hospital bill or surgery expenses, but less so if you need to get a cavity filled or an eye exam.
Although dental, vision and hearing are not part of any of the standardized Medigap plans, insurance providers offer several affordable plans that eligible adults can tack on to their Medicare supplement plan for an extra monthly fee. These plans are considered separate riders, though, and not a form of supplemental Medicare.
What If You Have a Medicare Advantage Plan?
As a private plan, Medicare Advantage plans are able to provide coverage for things Original Medicare doesn’t cover, and that includes dental, vision and hearing services. With that comes basics like routine eye exams, dental cleanings and hearing aids.
Even with the additional plan benefits, a plan can choose not to cover the cost of services that are not deemed “medically necessary.” So it’s important to check your plan before you get a service.
Do Medicare Advantage Plans cover LASIK surgery?
Some Advantage plans cover LASIK, the laser surgery used to correct vision. But since it’s an elective procedure, it’s worth checking with your provider to see if it’s included in your plan.
Which Medicare Advantage plan has good dental coverage?
That depends on which services matter the most to you. The same goes for finding the right Advantage plans with vision and hearing coverage. Consider your individual needs when it comes to things like routine exams, cleanings, X-rays, treatments and dentures, and look for plans that are readily available and priced competitively.
