Healthcare for American seniors over 65 is often encapsulated in one word, “Medicare,” but, if you’re on the precipice of enrollment, you may have realized that your healthcare choices are a little more complicated.
In particular, vision and dental care are two healthcare coverages that can greatly improve your quality of life. Learning about Medicare and dental service options or Medicare’s treatment of vision care can help you decide what kind of healthcare plan is right for you.
Does Medicare Cover Dental Services?
If you’re hoping Medicare will cover your dental services, you’ll likely be waiting a while. Original Medicare doesn’t cover things like dental cleanings and only covers dental services under two circumstances.
The first instance is if you’re hospitalized because your dental health is related to an underlying health condition, or because your dental health is so severe. In this case, Medicare Parts A and B will cover the inpatient dental procedures necessary.
The second instance is if your dental care is related to a different, non-dental medical treatment. A few examples include dental exams performed before a heart valve replacement, a bone marrow transplant, or a tooth extraction before someone undergoes treatment for mouth or throat cancer.
For more on how Original Medicare covers dental care:
Does Medicare Advantage Cover Dental?
The majority of Medicare Advantage plans offer some kind of dental coverage as part of their package. In fact, more than 80 percent of Advantage plans include basic dental. If your Advantage plan doesn’t cover dental. You may be able to get dental coverage as a buy-up service that you can add for an additional monthly cost. Like all Medicare Advantage plans, dental coverage will be limited to specific networks.
If dental coverage is an essential part of your Medicare journey, Advantage plans may be attractive. But remember that including dental coverage is hardly the only aspect of your coverage to consider — you want to feel comfortable with the full range of services and coverages with whatever healthcare option you decide.
Dental Insurance for Seniors
If you’re leaning toward Original Medicare or a Supplemental plan for your healthcare past 65, you may choose a standalone dental policy to cover those services.
A standalone dental policy may cost $30 to $60 per month, and will likely involve a network of some kind. Many dental plans have waiting periods for some procedures and annual plan caps, after which you are on the hook for 100 percent of payments.
Under most plans, preventative coverage starts immediately and is covered at 100 percent. That means you likely won’t pay much if anything for a standard two cleanings and an X-ray each year. Basic fillings may have a waiting period of 6 months, and a typical plan may cover them with an 80/20 coinsurance, with the insurer covering 80 percent of the cost and you paying out of pocket for the remaining 20 percent. Major dental procedures like crowns or root canals may have a waiting period of 12 months before a newly insured patient can access the care and may be billed in a 50/50 split, with you on the hook for half the cost.
How to Get Dental Coverage with Medicare
There’s no easy choice. Medicare Advantage is likely the least expensive option for dental coverage, but may come with other drawbacks for your overall healthcare coverage, like smaller networks and prior authorizations. If you go with Original Medicare, you may need to purchase supplemental dental insurance at an additional cost. Or, you may decide it’s better to self-pay.
If you choose to pay for all dental services out of pocket, remember that seniors who use dental services of any kind have an average $800+ out-of-pocket cost every year.
Whichever funding option appeals to you will undoubtedly be based on your general health and the resources at your disposal, and should take a holistic approach to your healthcare.
Does Medicare Cover Eye Exams?
Original Medicare offers a lot more for people concerned about their vision than those who are worried about their teeth. While the program doesn’t cover routine annual eye exams or basic lensware, more advanced medical eyecare is covered with Original Medicare.
While Medicare doesn’t cover “routine” annual exams the program picks up the bill for medically necessary exams to diagnose or treat eye disorders and diseases. From cataracts to glaucoma, astigmatism to macular degeneration, Original Medicare Part B may pay for vision care if it’s a medical condition beyond standard blurry vision.
If you want to get an upgraded lens prescription as part of your normal annual checkup, Medicare won’t cover that. But if you’re a diabetic whose normal annual checkup includes an exam for diabetic retinopathy, then that’s covered.
Medicare Advantage Vision coverage
Medicare Advantage plans will cover the advanced care that Original Medicare offers (albeit, as always, as part of a network and with prior authorizations required). However, unlike Original Medicare, Advantage plans may also provide coverage for an annual routine eye exam and the cost of a new set of frames and lenses each year, perhaps up to a dollar limit.
Vision Plans for Seniors on Medicare
Like dental insurance, you can get a vision plan for routine annual eye exams and glasses or contacts as standalone coverage. Plans range from $12 to $20 per month, but cost-effectiveness will be up to you.
Ultimately, you can also self-pay for routine vision services, but keep in mind that an annual eye exam may cost $150 or more, and glasses could be $200.
Finding Dental and Eye Care Insurance for Seniors with Medicare School
Whether you choose a Medicare Advantage plan with vision and dental coverage, opt for standalone vision and dental plans, or choose to pay out-of-pocket, there are always risks to weigh. We hope this post has helped you explore your options, but if you need someone to help you choose the best choice based on your situation, Medicare School is here to help. Schedule an appointment with one of our Medicare guides, and we can talk through the pros and cons of each option and even help you find the plan that works within your budget.
Interested in learning more about Medicare? Enroll in our free online Medicare workshop or give us a call now.