By Marilyn Katz
Does Medicare Cover Dental and Vision?
Medicare is the US health insurance plan for seniors and disabled people. It provides basic medical coverage, and it really helps our seniors and disabled pay for health care. But original Medicare does not pay for everything, and dental or vision benefits are very limited.
Routine care, like checkups, fillings, and glasses, are not usually covered. Services may be covered if they are associated with a medical issue like an illness or injury.
For example, Medicare may pay for a hospital stay in the case of a complicated dental procedure. But it may not cover the actual dental work. For another example, Medicare does not usually cover eyeglasses or contacts. However, it will pay after intraocular lens cataract surgery.
Does this sound complicated?
Well, it can be hard to understand when services will be covered and when they won't be. In any case, even covered services may require a deductible and copayments, so a patient is likely to have out of pocket costs if they have original Medicare.
The answer is even more complex if the benificiary has other benefits. Some Medicare Advantage (MA) plans, for instance, do cover some routine dental work. Other people may have additional coverage through a retirement health insurance plan. But most covered people, even with supplements or MA plans, do not have extra dental and vision benefits. So some beneficiaries may have covered services, while some do not.
How do you know what benefits you are entitled to?
Medicare.gov is a great resource. This website, run by CMS (Center for Medicare and Medicaid) actually answers many questions like this. You can also look up information on Medicare Advantage plans. If you have trouble using the website, they also provide a 1-800 contact phone number and email address. If you are a beneficiary, or care for one, you should become familiar with this website!
Another great resource would be your supplemental health insurance company. Call the customer service number and ask. MA plans, medi-gap health insurance, and retirement benefits will all be run by private companies. If you want to seek services you can call to make sure they will be approved.
What if a Medicare Beneficiary has No Coverage
We are all concerned with our eyesight and teeth. But these services can be expensive. It may be time to explore some alternatives before you have an emergency need.
Dental Insurance - I am not surprised to see a lot of dental insurance that is being marketed to seniors. Keep in mind that not all services will be covered, and you are likely to have deductibles, copays, and yearly maximums that are specified in any policy. The coverage can help you plan for expenses, but is not likely to totally eliminate all costs.
Dental Discount Plans - These are not insurance plans, but allow members to access networks of service providers who agree to discount services. This is similar to the negotiated price benefit associated with some PPO or HMO health insurance or dental insurance plans. While discount plans do not actually pay for services, they can help members save a lot of money. Some also include vision networks.
Community or Government Dental and Vision Care - I have seen ads for dental clinics, ad even mobile dental care vans, at local community centers. Many church or community sponsored centers will have information on reduced fee clinics for seniors, disabled people, or others with low income. The federal government, state, or county may also run reduced fee clinics in some areas. Your local health and human resources offices should have information. There is help out there for older people, but it can take some digging to find it.
Do you need more help?
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