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.
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. If you go with Original Medicare, you may need to purchase supplemental dental insurance at an additional cost. You may decide it’s better to self-pay. Or if you contact a licensed agent you may be able to find a plan that includes dental.
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.
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
Regardless of the options you choose to cover Dental and Vision 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. Enroll in our free online Medicare workshop.