Medicare, the federal health insurance program for people aged 65 or older, as well as for certain younger individuals with disabilities, is designed to provide comprehensive healthcare coverage. However, one aspect that many beneficiaries find themselves searching for is dental and vision coverage. Original Medicare (Parts A and B) does not cover routine dental or vision care, such as exams, cleanings, dentures, or glasses, which often leads beneficiaries to wonder: How can I get dental and vision coverage with Medicare?
In this blog, we’ll walk you through your options for adding dental and vision coverage to your Medicare plan, and how to navigate the often complex world of Medicare supplemental benefits. Whether you’re just about to enroll or are currently a beneficiary, understanding these options will help ensure you get the care you need.
1. What Does Original Medicare Cover?
Before diving into your options for adding dental and vision coverage, let’s review what Original Medicare (Parts A and B) covers:
- Part A: Hospital insurance. This helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health services.
- Part B: Medical insurance. This covers outpatient services, such as doctor’s visits, lab tests, durable medical equipment, and some preventive services.
While Medicare Part A and Part B provide extensive coverage for hospital and medical care, they do not include routine dental or vision services. This means that most dental procedures (like cleanings, fillings, and crowns) and eye care (such as eye exams and glasses) are not covered. So, if you need these services, you’ll need to look into additional coverage options.
2. Option 1: Medicare Advantage (Part C)
One of the best ways to get dental and vision coverage with Medicare is through a Medicare Advantage (Part C) plan. Medicare Advantage is an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans combine the benefits of Part A and Part B and often offer extra coverage for services that Original Medicare does not cover, including dental, vision, and hearing.
What Medicare Advantage Plans Offer
- Dental Coverage: Many Medicare Advantage plans offer routine dental coverage, including cleanings, exams, fillings, and sometimes even more advanced procedures like dentures or crowns. However, the extent of coverage can vary greatly depending on the plan.
- Vision Coverage: Medicare Advantage plans often include coverage for eye exams, glasses, and contact lenses. Some plans may even offer discounts on Lasik surgery or other specialized treatments.
- Hearing Coverage: Some Medicare Advantage plans also offer hearing exams and coverage for hearing aids.
How to Choose the Right Medicare Advantage Plan
When considering a Medicare Advantage plan, it’s important to review each plan’s coverage carefully. Not all plans will cover the same dental or vision services, and some may have additional costs, such as copays or premiums. Here are a few factors to consider:
- Network Providers: Medicare Advantage plans often require you to use specific doctors and healthcare facilities within their network. Make sure your preferred dental and vision providers are included.
- Monthly Premiums and Out-of-Pocket Costs: Some Medicare Advantage plans may have higher premiums or deductibles, and you may need to meet certain copayments or coinsurance for services. Weigh these costs against the benefits of added coverage.
- Coverage Limits: Be sure to understand any limits on coverage. For example, a plan may only cover a certain number of cleanings per year, or there may be a cap on the dollar amount covered for dental or vision services.
- Plan Ratings and Reviews: Look at online ratings and reviews of Medicare Advantage plans in your area to understand the quality of care and customer service. The Centers for Medicare & Medicaid Services (CMS) rates plans on a scale of one to five stars.
How to Enroll in a Medicare Advantage Plan
You can enroll in a Medicare Advantage plan during your Initial Enrollment Period (IEP), which begins when you first become eligible for Medicare, or during the Annual Election Period (AEP), which runs from October 15 to December 7 each year. Changes made during this time will take effect on January 1 of the following year.
3. Option 2: Medicare Supplement (Medigap) Plans
Medicare Supplement Insurance, also known as Medigap, helps pay for the out-of-pocket costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles. However, Medigap plans do not provide additional coverage for dental or vision services.
If you are looking for dental and vision coverage and already have a Medigap policy, you will likely need to explore other options to get these services covered.
4. Option 3: Standalone Dental and Vision Plans
If you’re not interested in switching to a Medicare Advantage plan, or if your Advantage plan doesn’t offer the dental and vision coverage you need, you can purchase standalone dental and vision insurance plans. These plans are available through private insurers and can be tailored to fit your needs.
Benefits of Standalone Plans
- Flexibility: Standalone dental and vision plans allow you to keep your Original Medicare (Parts A and B) or Medigap coverage, while adding the dental and vision services you need.
- Cost Control: These plans often have lower premiums than Medicare Advantage plans, making them a good option if you want to save money while getting the care you need.
- Variety of Plans: Standalone plans come in a variety of options, including basic dental coverage, comprehensive dental coverage, and vision care, such as eye exams and glasses.
How to Choose a Standalone Plan
- Coverage: Ensure that the standalone plan offers the services you need, whether it’s routine dental check-ups, fillings, crowns, or vision exams and glasses.
- Costs: Compare the premiums, deductibles, and copays of various standalone plans. Be mindful that the lowest premium may not always offer the most comprehensive coverage.
- Network: Just like Medicare Advantage plans, standalone dental and vision plans may have networks of providers. Check if your current dentist or optometrist is included.
5. Option 4: Medicaid for Low-Income Beneficiaries
For those who are eligible for both Medicare and Medicaid (often referred to as dual eligible), there may be additional dental and vision benefits. Medicaid varies by state, but many states offer expanded dental and vision coverage for low-income individuals who qualify.
Medicaid Coverage for Dental and Vision
- Dental: Medicaid may cover a wider range of dental services than Medicare, including preventive care (cleanings, exams) and treatments (fillings, extractions). However, coverage levels and types of services can vary by state.
- Vision: Medicaid may also cover routine eye exams, glasses, and sometimes even more specialized treatments, depending on the state.
To find out whether you’re eligible for Medicaid and what benefits it offers in your state, contact your state’s Medicaid office or visit the official Medicaid website.
6. Other Tips for Managing Dental and Vision Care with Medicare
- Preventive Care: Even though Original Medicare doesn’t cover routine dental and vision care, it does cover certain preventive services that may help you avoid more expensive treatments later. For example, Medicare covers one eye exam per year for people with diabetes to monitor for diabetic retinopathy.
- Shop Around: If you decide to purchase a standalone dental or vision plan, take the time to shop around and compare different providers. Plan prices and benefits can vary widely.
- Check with Your Providers: If you have a specific dental or vision care provider you want to continue seeing, confirm that they accept the insurance plans you are considering. This will help you avoid paying out-of-pocket for services that could otherwise be covered.
Conclusion
Getting dental and vision coverage with Medicare is possible, but it requires you to be proactive in exploring your options. Whether you choose a Medicare Advantage plan, purchase a standalone plan, or explore Medicaid benefits, there are several paths to ensuring you have the coverage you need.
By understanding the different types of plans and carefully considering your needs and budget, you can make an informed decision about the best way to secure dental and vision care as a Medicare beneficiary. Make sure to review your options annually, especially during the open enrollment periods, to ensure your coverage continues to meet your healthcare needs.
