Original Medicare (Medicare Part A and Part B) does not cover routine dental or vision care. There are certain circumstances under which Original Medicare may provide some coverage for dental or vision care in an emergency setting or as part of surgery preparation.
However, you may be able to receive routine dental and vision coverage by enrolling in a Medicare Advantage plan that includes dental and vision benefits.
Medicare Advantage (Medicare Part C) plans provide the same basic benefits that are covered by Original Medicare. Many Medicare Advantage plans also include coverage for other benefits that Original Medicare does not.
Many Medicare Advantage plans offer coverage for things such as:
Medicare Advantage plans in your area may offer some of the benefits listed above and more.
Some Medicare Advantage plans require a monthly premium, but some plans in your area may feature $0 premiums. Deductibles and coinsurance requirements will vary by plan.
In 2021, more than one out of every three Medicare beneficiaries are enrolled in a Medicare Advantage plan.1
A Medicare Advantage plan with dental coverage may offer benefits that could include:
The specific coverage offered by your plan may not include all of the items listed above. Check with your plan carrier to learn more about the terms of your Medicare Advantage plan dental coverage.
A Medicare Advantage plan with vision benefits may cover things like:
Some Medicare Advantage plans may even offer coverage for specific retailers, such as frames from Warby Parker.
Check with your plan carrier to learn more about the terms of your Medicare Advantage plan vision coverage.
Medicare Supplement Insurance, also called Medigap, does not provide coverage for dental or vision care. Instead, these plans provide coverage for some of the out-of-pocket costs associated with Original Medicare such as deductibles, copayments and coinsurance.
Medicare Supplement and Medicare Advantage are not the same thing. Medigap plans may not be used in conjunction with a Medicare Advantage plan.
If you have Original Medicare coverage and receive vision or dental care under one of the specific instances that are covered by Medicare Part A or Part B (detailed below), your Medigap plan may be able to help pay for some of your Medicare coinsurance costs, depending on which plan you have and the type of treatment you receive.
You can learn more about Medicare Supplement Insurance by reading this helpful guide.
Original Medicare covers limited dental care. It does not cover most dental care or supplies, such as:
However, Medicare Part A (hospital insurance) will typically provide some coverage if you receive any dental services in a hospital as an inpatient.
"Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isn’t covered," according to Medicare.gov.
If you need dental coverage for routine dental care services and supplies, you may want to enroll in a Medicare Advantage plan that includes that benefit.
Original Medicare also covers limited vision care. It does not cover routine eye exams for contact lenses or glasses.
However, Medicare Part B (medical insurance) will cover some preventive or diagnostic eye exams, including glaucoma tests, yearly eye exams to test for diabetic retinopathy and eye tests for macular degeneration.
Medicare will typically cover cataract surgery to implant an intraocular lens if it’s performed with traditional surgical techniques or with lasers.
Following the procedure, Medicare Part B will typically provide some coverage for corrective lenses. The coverage for corrective lenses under these circumstances is limited to one pair of eyeglasses with standard frames or one set of contact lenses.
Medicare also covers eye prostheses for patients with an absence or shrinkage of an eye due to a birth defect, trauma or surgical removal. Coverage includes polishing and replacements every five years.
If you need vision coverage for routine services, you may want enroll in a Medicare Advantage plan that includes that benefit.
Medicare Part B does not provide any coverage for routine eye exams, but Part B will typically cover some preventive or diagnostic eye exams for patients who are at risk of certain diseases or conditions.
An annual glaucoma test may be covered by Medicare Part B if you are at a high risk of glaucoma due to having diabetes, a family history of the disease, Hispanic and age 65 and older or African American and age 50 and older.
Glaucoma is a condition that causes damage to the optic nerve and can lead to permanent vision loss if left untreated.
Age-related Macular Degeneration (AMD) is the leading cause of vision loss and remains incurable. It is caused by the deterioration of the central portion of the retina.
Medicare Part B can provide coverage for certain diagnostic tests and treatments if you have AMD.
Those with diabetes carry the risk of developing diabetic retinopathy, which is a complication of diabetes that damages blood vessels in the retina and affects vision.
An annual exam for diabetic retinopathy can be covered by Medicare Part B if you have diabetes.
If qualified for any of the above coverage, you will pay 20 percent Part B coinsurance for services and items and the Part B annual deductible applies.
Medicare Part B typically provides coverage for tests designed to diagnose cataracts. A cataract is a clouding of the eye’s natural lens and is the leading cause of blindness around the world.
Medicare will generally cover a diagnostic eye exam to determine the type and extent of an injured eye. Coverage typically extends to eye infections and treating foreign objects in the eye.
Any such vision services that are received as a hospital inpatient may be covered under Medicare Part A.
Medicare Advantage plans can come in a variety of types, such as HMOs or PPOs.
The type of plan you have may affect which dental or vision providers you can visit in your plan network. Before enrolling in a plan, it’s wise to check the plan’s network participants to see if your favorite dentist or optometrist accepts the plan.
Call today to speak with a licensed insurance agent who can help you find Medicare Advantage plans in your area that may offer dental and vision coverage.
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1 Fugelsten Biniek, J. et al. (Oct. 29, 2020). Medicare Advantage 2021 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2021-spotlight-first-look.