Medicare Coverage for Dental, Vision, and Hearing

Dental Coverage

There are many reasons for needing dental care; routine exams and cleanings are needed by everyone. Dental problems, such as gum disease and cavities may be due to due to natural events or are caused by certain medications, such as those prescribed for high blood pressure, high cholesterol, and Alzheimer’s.

Dental care can be very costly, so having insurance to help cover those costs is important. Prices for the necessary services vary according to several factors, including location. Here are some typical ranges: routine visit with exam and X-Rays, $100 to $350; regular cleaning, $75 to $225, with deep cleaning at $500 to $3,500; cavity filling: $50 to $4,000 (depending on several factors, including the type of filling used); and standard extraction at $75 to $250 per tooth; extraction of impacted teeth can be $700 to $4,500.
The costs of such things as dentures, crowns, and bridges, can be even higher. Understanding what Medicare covers and doesn’t cover is important.

Dental Services Covered by Medicare

Original Medicare generally doesn’t cover most dental services. Routine and preventive care, such as exams and cleaning are not covered. Nor are dental problems that have taken time to develop; fillings, extractions and dentures are not covered.

What may be covered by Medicare is dental work that is needed due to an emergency or specific complication. For example, if you are in an accident that injures your teeth, mouth, or jaw, Medicare might cover the inpatient care. It’s important to understand the gaps in coverage, and not to rely on Medicare for your dental needs.

Original Medicare generally doesn’t cover most dental services. Routine and preventive care, such as exams and cleaning are not covered. Nor are dental problems that have taken time to develop; fillings, extractions, and dentures are not covered.

What may be covered by Medicare is dental work that is needed due to an emergency or specific complication. For example, if you are in an accident that injures your teeth, mouth, or jaw, Medicare might cover the inpatient care. It’s important to understand the gaps in coverage, and not to rely on Medicare for your dental needs.

Medicare Supplement Coverage

Since Medicare Supplement (Medigap) coverage is based on services approved by Medicare, it typically doesn’t cover routine or preventive services, and only supplements some approved emergency services.

Medicare Advantage

Although Original Medicare generally doesn’t cover dental services, many Medicare Advantage plans do. Medicare Advantage, also known as Medicare Part C, are more comprehensive plans, bundling several types of coverage together, often including some DVH benefits. Note that dental coverage is not included in all Medicare Advantage plans, although it is in most plans, so it’s important to check for it before enrolling.

There are many benefits to dental coverage through Medicare Advantage.

  • Unlike most types of insurance that require you to pay premiums for a set period before they provide coverage, or require you to pay a deductible first, a Medicare Advantage plan generally does not require a waiting period before coverage goes into effect, which allows you to get care immediately after enrolling.
  • Also, unlike many types of insurance, there is no limitation for pre-existing conditions. Medicare Advantage offers coverage regardless of when the issue started.
  • Medicare Advantage plans with dental coverage generally offer such routine and preventive services as:
  • Teeth Cleanings
  • Oral Exams and Diagnostic Services
  • Dental X-Rays
  • Endodontics (root canal treatments)
  • Extractions
  • Restorative procedures, such as fillings
  • Periodontics (treatment of oral inflammation, gum disease, and similar issues)
  • Prosthodontics (crowns, dentures, implants, and bridges)

As beneficial as this may be, you should also know there may be some limitations to Medicare Advantage plans. For example, many MA plans cover:

  • The requirement to use only network providers
  • Only one set of X-rays each year
  • No more than one cleaning every six months
  • Only one extraction per year

To avoid unpleasant and costly surprises, be sure to check the policy pages provided by your insurer that expressly state the extent of the coverage and any limitations.

Vision Coverage

Much like dental coverage, Original Medicare does not provide routine vision coverage; it is limited to emergency and specific complications.

Again, one way of getting coverage is to enroll in Medicare Advantage, which may help with the following:

  • Routine optometry exams
  • Contact lenses
  • Eyeglass lenses and frames

As with dental coverage, it’s important to read the carrier’s policy pages for any limitations, including the required provider network.

Hearing Coverage

Here again, Original Medicare only covers conditions caused by an emergency event, or as a complication of specific medical events. There is no coverage for routine hearing services, or hearing devices.

Medicare Advantage plans may offer routine hearing services, as well as some assistance with the cost of hearing aids and other hearing devices. Most plans have a set copayment or offer a “Maximum Benefit,” so it’s important to check the policy pages to determine the specifics.

Stand-alone Plans

One alternative for help with out-of-pocket dental, vision, and hearing (DVH) costs is to purchase a stand-alone insurance policy that is unrelated to Medicare. There are several ways to configure coverage, and several prominent companies to choose from.

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