It’s possible that a Medicare Advantage Plan would be preferable to Original Medicare if only for its dental and vision coverage. Find out what kinds of insurance protection you can get through this federal initiative.
Dental and vision coverage under Original Medicare (Parts A and B) is extremely limited and may not meet your needs. A Medicare Advantage Plan may be the best choice if you require more extensive medical coverage. Numerous private businesses provide their employees with such plans, each of which may offer a unique set of advantages. Keep reading to learn how to get Medicare to pay for your vision and dental care.
Does Medicare cover dental and vision?
If you have Original Medicare (Parts A and B), Medicare Interactive informs you that the majority of the dental care you require for routine oral health maintenance is not covered.
- Routine checkups
- Cleanings
- Fillings
- Dentures
- Tooth extractions
Unless you have dental insurance, you will likely be responsible for paying the full price of any of these procedures if you decide to have them done.
Medicare does not cover preventative dental care or care for the maintenance of healthy teeth, but it does cover a small number of dental procedures that are either essential to your overall health or necessary for the success of another medicare-covered health service. It could include things like:
- Medical checkup of the mouth before a kidney transplant.
- Radiation therapy for oral cancer must precede dental treatment.
- After a facial tumour has been removed, the jaw bone must be reconstructed.
- Restoration of facial or jaw fractures through surgical intervention.
- Prior to undergoing heart valve replacement, an oral exam is recommended.
- Post-operative dental splints and wiring for the jaw may be required after jaw surgery.
Medicare will pay for the initial dental services, but not for any dental care needed after the initial treatment or procedure is finished.
If a patient’s dental health is critical, Medicare will pay for hospitalisation and related dental procedures. Only the expense of hospitalisation will be covered, not visits to the dentist or other medical professionals.
Regular eye exams for contact lenses or glasses are not covered by Medicare either. Medicare does cover some eye care services, however, if you have a chronic eye condition like cataracts or glaucoma.
- Because of a long-standing problem with one’s eyes, surgical intervention is required. Surgery to remove cataracts and replace the natural lens of the eye with an artificial lens is one example of a procedure that is covered by Medicare.
- After cataract surgery, you may need corrective lenses such as contact lenses or eyeglasses. However, Medicare will only pay for a non-polarized pair of glasses or contacts in such cases. Only in cases where they are deemed medically necessary will Medicare cover the cost of prescription eyewear that has been modified to fit the patient.
- Vision loss could be a sign of a more serious health issue, so it’s important to get your eyes checked.
Patients with diabetes and/or those at high risk for glaucoma are eligible for Medicare coverage of routine eye care. Those with a greater likelihood of developing glaucoma include:
- Diabetic individuals
- The predisposition to glaucoma increases in those who have a history of the disease in their
- Blacks over the age of 50
- Those who are 65 and older and of Hispanic descent
Dental and Vision Insurance for Medicare Recipients
According to the Centers for Medicare & Medicaid Services, “MA plans” (Medicare Advantage Plans) or “Part C” (Medicare Advantage Part C) can provide you with dental and vision coverage if you qualify. All Medicare Part A and Part B services are included in MA plans, plus additional services like vision and dental care. Private insurance companies that have been granted Medicare’s blessing offer MA plans that comply with Medicare’s standards.
Christian Worstell, a licenced health insurance agent in Raleigh, NC, tells WebMD Connect to Care that enrolling in a Medicare Advantage plan is how millions of older adults obtain dental coverage. In addition to the services provided by Original Medicare, enrollees in these plans may also receive additional services, such as those for their teeth, ears, and overall well-being, for little to no additional cost each month. Enrolling in a Medicare Advantage plan that includes dental coverage is typically less expensive than enrolling in a separate dental insurance plan.
The following services, which are not included in traditional Medicare, may be covered by MA plans:
- Fitness programs (gym membership and discounts)
- Vision care services
- Dental health services
- Hearing care services
- Over-the-counter drugs
- Transportation
Medicare Advantage Plans come in a variety of forms, so it’s important to shop around before settling on a provider. One of the MA plans is open to you if you meet the following criteria, as stated by the Centers for Medicare and Medicaid Services:
- You have Medicare Part A and Part B.
- You are a citizen of the US or residing lawfully in the US.
- You reside within the service area covered by your chosen plan.
Medicare Advantage plans in your area can be found by visiting the official government Medicare website. You should find out if the plan you’re considering will cover you if you spend part of the year in another state.
AARP Medicare Dental and Vision Plans
Raleigh, North Carolina-based licenced health insurance agent Christian Worstell tells WebMD Connect to Care that the American Association of Retired Persons (AARP) works with UnitedHealthcare to market Medicare Advantage plans. Medicare Advantage plans, also known as Medicare Part C, are a type of Medicare supplement that typically includes coverage for preventive services like dental and vision care, which are not provided by Original Medicare.
Lindsay Malzone, Medicare Expert at Medigap.com, tells WebMD Connect to Care that “in most cases,” dental and vision plans are not supplemental plans that you add to coverage, but rather the coverage that is inclusive of your chosen plan. This is why reading your plan materials thoroughly before settling on a plan is so important. You should pick a policy that includes all the essentials.
Services that are both preventative and basic in scope will be included in [AARP Medicare Advantage Plans]. Malzone explains that these perks are frequently included in plans because their utilisation costs are low.
Dental, vision, and hearing care, in addition to prescription drug coverage, are not included in Original Medicare, but are included in Medicare Advantage plans like those offered by AARP/UnitedHealthcare. In addition, all Medicare Advantage plans are mandated by law to have a maximum out-of-pocket cost for their members. Worstell explains that “original Medicare has no such out-of-pocket limit.”
However, “while these benefits are great additions and low cost, there are a few drawbacks,” Malzone says. However, they are restricted in what they can do. For instance, your dental plan may only pay for two extractions per year, or you may not be able to get transition lenses for your glasses.
The network is always the main source of discontent. Not all dentists and eye doctors accept Medicare Advantage’s supplemental dental and vision insurance. The best defence against this is to call the customer service number listed on the back of your card and provide detailed information about the problem. Have them locate a dentist in your area who accepts the plan and can carry out extractions if necessary. The same goes for your eyes and ears, so make sure to take advantage of those resources! In this explanation, Malzone fills us in.
Other Medicare Vision and Dental Plans
Humana Medicare Advantage Plans
Humana’s Medicare Advantage plans provide comprehensive coverage similar to that of traditional Medicare (Parts A and B). Though the availability of particular plans may vary from one region to another, many of them provide supplementary advantages such as:
- Guaranteed Dental Care
- Protecting Your Eyes
- Payment for Medications Required By Prescription
- Routine checkups and immunisations are paid for each year.
- Acupuncture and other complementary therapies are included.
Benefits are contingent on the Humana plan you select. You can learn more about the plans that are available to you and make an informed decision by visiting the Humana website.
Aetna Medicare Advantage Plans
These plans focus on your health and wellness as a whole and are among the most common types of Medicare Advantage Insurance. Dental and drug coverage are standard features of Aetna’s Medicare Advantage plans. Aetna’s “Ask a Nurse” phone hotline, routine vaccinations, and home delivery of medications may also be included in some plans.
Cigna Medicare Advantage Plans
Medical costs are covered to a greater extent than under Original Medicare by these plans, as is the case with the vast majority of MA plans. Numerous of these packages consist of coverage for vital medical procedures like:
- Vision
- Dental
- Hearing
- Wellness programs
- Discounts on health-related items
Many plans also offer Part D or prescription drug coverage.
Kaiser Medicare Advantage Plans
Most states have reported high levels of customer satisfaction with the Kaiser Medicare Advantage Plan. Kaiser only provides Health Maintenance Organization (HMO) plans. This plan has lower monthly premiums, but you are limited to using doctors and hospitals that are part of its provider network. All Kaiser network doctors are either board-certified or board-eligible, guaranteeing you’ll get the best care possible.
Anthem Blue Cross and Blue Shield Medicare Advantage Plan
Benefits such as dental, vision, hearing, and prescription drug coverage are included, as stated on the Anthem website. In addition, they may pay for extra perks that can help you feel better all around, like:
- Cost-free access to fitness resources
- Benefits for Nonprescription Medicines
- Medical centre transportation
- Providers of Individual Dispatch for Emergencies
- Connecting patients with doctors around the clock via video chat
The Bottom Line
Although Medicare may seem complicated, it is actually quite simple. What follows is a rundown of the most crucial information regarding Medicare’s vision and dental plans.
- It’s important to remember that dental and vision care are not fully covered by Original Medicare (Parts A and B).
- Medicare Advantage plans, also known as MA plans or Part C, can provide you with supplementary dental and vision insurance if you qualify.
- Private insurance firms supply Medicare Supplement and Advantage plans.
- In contrast to Original Medicare, members of these plans are protected by a maximum out-of-pocket expense.
- Dental, vision, and hearing care, as well as prescription drugs, may be more broadly covered by AARP Medicare Advantage plans.
- Humana, Aetna, Cigna, Kaiser, and Anthem are just a few of the many insurance providers that offer Medicare Advantage Plans.
- Before deciding on a plan, you should weigh the pros and cons of each option.
