It’s important for seniors to know whether or not Medicare covers their vision and dental needs, and, if so, when does medicare cover vision and dental? If you’re asking yourself, “does medicare cover vision care?” or “does basic Medicare cover dental?” you may be struggling to find a clear and easily understood answer. You’re not alone. Healthcare coverage is confusing for most of us.
It’s true that original Medicare may not meet your coverage needs when it comes to both eye care and teeth care. But vision and dental should not be ignored, especially as we age. With each passing year, our eyes often need more care and our teeth are no different. Taking care of your teeth can prevent serious conditions in our later years, including pneumonia, mouth infections, and gum disease. Proper eye care in our senior years can prevent vision loss and overall quality of life. It’s crucial for seniors to be able to maintain routine dental and vision care.
But we know routine vision and dental care are expensive. When that care extends beyond the routine maintenance, it can become even more costly. In this guide, we’ll go over what Medicare covers with regards to your teeth and your eyes and how to make sure you’re minimizing your out-of-pocket costs while maintaining your vision and dental health.
So, does Medicare cover dental and eye care? Let’s jump in and find out.
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Medicare Part A and B, also known as Original Medicare, offers coverage for health care that has been deemed medically necessary. Vision and dental are two forms of health care that are not seen as medically necessary by Medicare. There are, however, some exceptions. So, when does Original Medicare cover dental and vision? Let’s take a closer look.
Does Medicare A and B cover dental? Medicare Part A may offer some Medicare dental coverage for procedures done in the hospital, sometimes as part of the preparation for surgery and other treatments. You may also receive coverage for dental care deemed an emergency. Does regular Medicare cover dental cleanings and regular checkups? No, for that you will need more coverage.
Does medicare A and B cover vision? Medicare Part B has some limited Medicare vision coverage for very specific vision care such as eye exams for the purposes of diagnosing a condition, testing for diabetic retinopathy, glaucoma, etc. Essentially, vision care that Medicare sees as medically necessary.
Glaucoma is a condition that causes degenerative damage to your optic nerve. If you are at risk of developing glaucoma, proper care is required to maintain your vision. For seniors over 60 years of age, glaucoma is consistently near the top of the list of causes of blindness.
Those who are at significant risk of developing glaucoma can have their routine glaucoma tests covered each year. You are at high risk if you have diabetes, glaucoma in your family history, are an African American who is 50 years of age or older, or are Hispanic and are 65 years of age or older. Your Medicare deductible will apply and you may have to pay a copay and a portion of the costs of the glaucoma tests.
It is commonplace for men and women over 50 to develop macular degeneration. Macular degeneration affects a part of your eye, called the macula, that makes your vision clear. As such, macular degeneration can cause blurred and deteriorating vision.
Medicare Part B covers some of the diagnostic tests that determine if you have macular degeneration. You may also receive coverage for the treatment of macular degeneration. Like coverage for glaucoma screenings, you may have to pay a copay, you will have to pay your Medicare deductible and you will have to pay 20% of the Medicare-approved cost for macular degeneration screenings.
A complication of diabetes, diabetic retinopathy is caused by damaged blood vessels in the eye and the condition can lead to blindness. It’s important to diagnose the condition as soon as possible for treatment.
Medicare Part B will cover your diabetic retinopathy diagnostic exams each year if you are already a diabetes patient. You will have to locate a doctor who is legally allowed to perform this exam in your state in order for you to get coverage. You will have to pay 20% of the Medicare-approved amount as well as your deductible and, in some cases, you’ll have a copayment.
Cataracts are the name given to a condition in which your eye’s lens clouds. This condition progresses slowly but can significantly impair your vision. Treatment is relatively easy using a small procedure to remove cataracts.
Cataract surgery, corrective glasses, contacts, or implants to treat cataracts may be covered by Medicare Part B. You will have to pay 20% of the Medicare-approved amount, as well as your deductible. In some cases, you may have a copayment.
Injuries can happen anywhere at any time and are more common than you might think. Does original Medicare cover vision when there has been an eye injury? Eye injuries are often covered by Medicare Part B when they are deemed medically necessary. You’ll have to pay out-of-pocket for 20% of the Medicare-approved cost, as well as your Part B deductible and in some cases, you may also have a copay.
So, does Medicare cover dental and vision care? Not when it comes to routine checkups, eye exams or dental cleanings and only when it’s an emergency or risk screening.
Medicare Advantage or Medicare Part C covers the same healthcare services as Original Medicare. However, with Medicare Advantage, there is additional coverage provided by private insurance companies that can sometimes cover some or all parts of vision and dental care.
Does Medicare Advantage cover vision? It all depends on your insurance provider but a lot of Medicare Advantage plans offer routine eye care.
Does Medicare Part C cover dental? The answer to this will also depend on the insurance provider you are with, but most Medicare Advantage plans will cover things like routine dental care. You may also find that your Medicare Advantage insurance coverage pays for your prescription drugs, hearing care, and much more.
The Medicare Advantage plans that you can choose from are going to vary depending on where you live. Let’s take a closer look at how some of these plans may cover vision and dental care.
Does Medicare Part C cover dental and vision? When does Medicare Advantage cover dental? The answer to this is going to depend entirely on what plans are available in your area and which plan you choose. Depending on the Medicare Advantage plan you have chosen, you may have Medicare dental and vision coverage for:
Because your Medicare coverage for dental and vision is going to depend on the Medicare Advantage plans available in your area as well as the plan you have chosen, you may have some or all of this coverage. To find out, take a look at your policy. If you’re shopping for coverage now, be sure to confirm what coverage you have for dental before making your final decision.
Many seniors wonder if Medicare Advantage covers vision as it’s an important part of our healthcare that should not be neglected. However, as it can cost a great deal to care for our eyes, coverage is often necessary. The good news is that many different Medicare Advantage plans do in fact cover vision care, but the exact coverage you end up with is going to depend on where you live and which plan you’ve chosen. Medicare Advantage plans differ from state to state, but many of these plans will offer coverage for things like:
The coverage you will have access to may or may not include all of these vision care services and it will depend on where you live and what plans are available to you. If you’re looking for a Medicare Advantage plan, verify what coverage options you have for vision care before making your final choice. If you’ve already got Medicare Advantage coverage, you can check your policy to find out what vision care is covered.
Medicare Supplement Insurance is also known as Medigap because it refers to a type of health care insurance that fills gaps in coverage left by Medicare. Medigap is different from Medicare Advantage plans. As we have already discussed, Medicare only covers that which is deemed medically necessary and vision as well as dental are not medically necessary according to Medicare.
So, does Medicare Supplement cover dental care to fill that gap left behind by Medicare? Does Medicare supplement cover vision?
Unfortunately, the answer is, for the most part, no. Medigap coverage is designed to cover the out-of-pocket portions of care already covered by Medicare. For instance, Medigap can cover your deductible. It may also cover copays, coinsurance, and any other out-of-pocket expenses associated with health coverage from Medicare.
You may be able to see some coverage for costs associated with vision and dental care, though. For instance, when Medicare Part A or B covers one of the specific eye or dental care services deemed medically necessary, like glaucoma screenings or exams for diabetic retinopathy, Medigap can cover your deductible, your copay, and coinsurance.
Original Medicare does not cover dental or vision unless it is medically necessary. That is to say, your vision and dental care will not be covered by Medicare Part A or B unless it is an emergency, pre-condition screening, or risk screening. But why won’t Original Medicare cover things like routine vision dental care?
The need for coverage is clearly there. A lack of access to vision and dental care can threaten the overall health of individuals and lead to conditions that are even more costly to treat. Without routine dental care, seniors are at risk of more emergency room visits, hospital stays and emergency treatment. Your vision and dental health is also closely tied to your quality of life. Without proper vision, your life can become limited. Deteriorating dental health can cause reduced self-esteem and it can get in the way of ensuring you’re getting proper nutrition. There is no doubt that dental and vision coverage is essential for seniors in the United States of America, so why doesn’t Original Medicare cover these services?
The answer, of course, is that it’s costly. The cost associated with including vision and dental care in programs like Medicare Part A and Part B as well as Medicaid would increase the budget for these programs by an estimated $358 billion between 2020 and 2029. If we break that figure down, we see $238 billion for dental care coverage, $89 billion would go to hearing care coverage, and $30 billion would be used to cover vision care.
The great news is that Bill H.R.3 has proposed adding comprehensive dental, hearing, and vision coverage to Part B of Medicare. Coverage would slowly increase over time beginning in 2025. So, there is the potential for better coverage in the near future.
If you’re currently making decisions regarding your health care coverage and you want to know how to ensure your coverage includes vision and dental, there are several steps you can take.
First, you want to make sure you select a Medicare Advantage plan. We have already discussed the fact that vision and dental coverage through Medicare Part A and Part B is extremely limited and only includes emergencies, that which is deemed medically necessary and risk screening. You know that with Original Medicare, you will not be covered for routine eye and dental care. So, you will have to choose a Medicare Advantage plan or buy extended healthcare insurance through a private provider. Companies like Cigna and Aflac offer dental coverage for seniors, while vision plans for people over 65 are available from companies like Spirit Vision and Direct Vision Insurance.
To begin searching for the right Medicare Advantage plan, you can start here and follow the prompts so see the plans available in your area. From there you will be able to compare and contrast coverage from these different plans. Each plan will list whether or not it covers dental and vision care and you’ll be able to see the cost of each plan to you.
If you already have Medicare Part A and B or Medicare Advantage and you want to check if your plan covers vision and dental costs, there are several ways you can go about it:
If you find out your Medicare Advantage plan does not have the coverage you’re wanting, you can make the changes to your plan that include vision and dental coverage during the Medicare Advantage open enrollment period from January 1 through March 31 every year.
Our content is created for educational purposes only. This material is not intended to provide, and should not be relied on for tax, legal, or investment advice. Everdays encourages individuals to seek advice from their own investment or tax advisor or legal counsel.