I need Dental, Hearing, and Vision Care. Can I get it through Medicare?

Medicare provides limited dental, hearing, and vision care. It covers some surgeries but no routine care. Available policies have limited coverage.

What Does Medicare Cover?

Medicare will not pay for routine care but may pay for testing if you have a condition like Glaucoma, Macular Degeneration, or Cataracts and will cover an annual eye exam for individuals with diabetes and those at high risk of glaucoma. It will cover surgical procedures to help repair your eye function if you have the above conditions as well as eye exams to diagnose potential vision problems.[1]

Medicare does not cover hearing aids. However, cochlear implantation is covered as a surgical procedure provided you have bilateral moderate or profound sensorineural hearing impairment that is not helped by hearing aids and if you meet a strict set of criteria. For information on this topic, see Cochlear Implantation.[2]

Medicare does not cover regular dental care. Some complicated dental surgery performed in a hospital setting may be covered by hospital insurance under Medicare Part A. Some conditions, such as tumor removal that necessitate tooth extraction, may be covered as may dental workups before renal transplants or heart valve replacements. See Medical Dental Coverage.[3]

How Can I Get Dental, Hearing, and Vision Coverage?

Some Medicare Advantage plans have limited coverage for dental, vision, and hearing care. Separate insurance plans may also be purchased. However, you need to pay close attention to what is covered by the plan you consider. Also, just because dental, hearing, or vision are covered,  it does not mean they are fully covered or that there is coverage from the first day of your policy.

Most plans have low premiums and cover some basic preventive exams such as two dental cleanings a year or perhaps simple exams for prescription glasses. You can find out what can be covered in your state at Dental, Vision, & Hearing Insurance Coverage for Seniors.[4]

Tip: Know what coverage you are buying before you buy.

What Problems Might I Have?

Dental plans, for example, may advertise themselves as covering endodontics, root canals, crowns, etc. However, in the fine print, it is common to find that you need to have the policy for six months before fillings are covered and a year before anything more complicated is paid for. You can expect the insurance company payout to be capped at something like $1,000 or $1,500 each calendar year. The larger the potential payout, the more expensive insurance will be.

You must also find out what percentage of the cost of “covered” services is covered.  It may be something like 60% of some scheduled amount after you have been enrolled in the plan for a year. Larger percentages might be covered after your second or third year of coverage. Some plans may cover much less.

Pay close attention to the language too. “Covers hearing aids” does not mean that you can buy hearing aids with the plan. It means that the plan covers some percentage of the cost after a stated waiting period. According to Consumer Reports, readers who bought hearing aids spent an average of $2,710.00 of their own money. 16% paid over $5,000.00.[5] You can see that a $1,000  maximum payout a year might not go far enough toward meeting your expenses to be worth the expense.

Before buying any health insurance plan, look at what it covers and make sure it is what you want.

Citations

  1. When Does Medicaid Cover Eye Care
  2. Cochlear Implantation
  3. Medical Dental Coverage
  4. Dental, Vision, & Hearing Insurance Coverage for Seniors
  5. 5 Ways to Cut Hearing Aid Costs