Understand your
Dental & Vision
Medicare options

The world of Medicare can be confusing when it comes to what’s covered by the different types of Medicare. If you’re focused on taking care of your oral and eye health, then it’s important to know exactly Medicare covers.

Learn what coverage you should expect.

Dental Coverage Vision Services

Dental Coverage

What can you expect from Medicare?

1Does Medicare cover dental?

Original Medicare does not cover most dental care. If you’re shopping for coverage for routine dental care, such as teeth cleaning and X-rays, and other dental care for fillings, extractions, dentures, and more, then Original Medicare doesn’t cover those things.

2What Medicare plans do offer dental coverage?

Medicare Advantage (Part C) is an alternative to Original Medicare for enrollees who want dental coverage. In 2021, estimated 92% of Medicare Advantage plans provided at least some dental coverage. But not all Medicare Advantage Plans cover dental. So before you sign up, make sure to read the details of what the plan covers.

3What do I need to pay attention to?

Medicare Advantage Plans (aka Part C), combine Original Medicare Part A and Part B into one complete plan. Private carriers MAY offer extra programs for dental coverage. If you are considering Medicare Advantage instead of Original Medicare + Medigap + Medicare Part D, be sure to familiarize yourself with the pros and cons of both options. You can get a non-biased opinion on all your Medicare options from an independent advisor.

4Do I have other options for dental care?

About 10% of retirees retain dental coverage from a former employer or a spouse’s employer. If you don't have that option, stand-alone dental plans are available for purchase, and some carriers offer dental plans that are specifically designed for seniors.

5In what circumstances will Medicare pay for dental coverage?

Medicare's coverage of dental care is limited to situations where the dental treatment is integral to other medical treatment (for example, an extraction prior to radiation treatment for oral cancer, or jaw reconstruction following an accident).

Dental Health

Nearly two-thirds of Medicare enrollees have no dental insurance at all while more than one in five Medicare beneficiaries have not seen a dentist in the last five years. An estimated 20% of Americans age 65+ have untreated dental cavities.

Did you know that your oral health impacts your overall health? There’s a significant link between untreated dental disease and various other systemic ailments, including heart disease and diabetes. Even some coverage is better than nothing. Even with low benefit maximums, people who have dental insurance are more likely to receive routine preventive dental care, and are less likely to have untreated dental problems that get worse over time.

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Medicare doesn't cover routine vision services but it will cover the cost of diagnosing and treating most eye diseases and conditions.

Vision Coverage

Medicare does not pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions. Seniors are not guaranteed complete vision coverage under Medicare, so it’s important to know what to expect.

Learn about Medicare Advantage

Understanding Vision Coverage

Although routine vision services are not covered, Medicare will provide Part B coverage for diseases and illnesses of your eyes, if it is medically necessary.

Luckily, there are dozens of individual insurance plans available at affordable prices that will help to cover your routine vision.

Medicare 863 understands the need for eye care during your retirement years. There are a number of ways in which you can reduce your expenditure on these items. I can help!

Get help now!

1Does Medicare cover vision?

Yes and No. Although routine vision services are NOT covered, Medicare will provide Part B coverage for diseases and illnesses of your eyes, if it is medically necessary. That means if you have glaucoma or macular degeneration or cataracts, your visits to an ophthalmologist for these conditions will be covered just like any other Part B services.

2How can I get routine vision services?

There are dozens of individual insurance plans available at affordable prices that will help to cover your routine vision. Many of these plans are bundled with routine dental and/or hearing services since those also are not provided for by Medicare. Medicare Advantage generally covers standard vision testing, as well as glasses or contacts. Original Medicare does not offer coverage for routine vision services; neither supplement insurance nor Medigap will pay for vision care or eyeglass benefits.

3How can Medicare Advantage cover my vision needs?

Part C of Medicare often give you options for routine vision coverage. These Medicare Advantage plans are an alternative to Original Medicare. The plan gets to decide how much it will offer for these benefits. For example, a vision benefit may provide an eye exam where you pay a copay, anywhere from $0 – $50 for the exam. Some plans offer just the eye exam and no coverage for glasses or contacts. Others, however, may include a credit or reimbursement toward the cost of the eyeglasses. This benefit could be anywhere from $50 – $200 toward the cost of glasses or contacts every year or two years, depending on the plan.

4What about just paying upfront for my Vision care?

You may find that the most economical way to pay for routine vision expenses is by shopping around for local providers and asking for the price of their eye exams. Ask about cash discounts too as some providers like to avoid the hassle of billing your insurance company. There are many reputable and caring vision providers who can provide care without breaking the bank. Don't forget, if you've contributed to a health savings account before retirement and still have funds left in it, you can use them to pay for your vision expenses. The IRS consider these qualified medical expenses, so you can use your HSA funds to pay for vision care.

5If my condition is medically necessary, what does Medicare cover?

Visits to an ophthalmologist for diseases like glaucoma or macular degeneration or cataracts will be covered with your Part B services. Part B has a deductible per calendar year, which is $203 in 2021. After that, it covers 80% of your Part B services. This means that visits to your eye doctors for illnesses like those listed above or even for minor eye infections or pink eye will be covered. This Part B benefit will also provide a pair of eyeglasses after a cataract surgery. If you purchase a Medigap policy, it will also help to cover some or all of the other 20%.

6How can a Medicare advisor help me?

An advisor can help you find a plan, but will also make sure you are following the necessary steps along the way to make sure you maximize the coverage available from your plan.

Get help from an expert!

When it comes to your oral and eye health, it is very important to know exactly what Medicare covers. An experienced, local independent advisor will help you navigate your options while building a relationship with you so you have longterm assistance in managing your coverage.

Did you know that Medicare Advantage plans change their benefits every year? The benefit that exists this year could be lowered or eliminated next year. An advisor will remind you that it is a good idea to use the benefit when you enroll in case the plan eliminates it the next year.

Also, if you qualify for coverage under Part B because your disease has been deemed 'medically necessary', Medicare Supplements cannot pay their 20% unless Medicare first approves your claim and pays its 80%, your supplement cannot pay either. It is important that you know what you are doing.

Finally, an advisor will know that Medigap plans, also known as Medicare Supplement Insurance, can help pay for healthcare costs Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

There are no additional fees, your premium will be the same as if you had bought the policy directly from the carrier
An advisor can save you money on your monthly premiums by comparing plans with all carriers vs just one carrier
Advisors can help keep you up to date and informed on any changes that happen annually
A relationship with a LOCAL advisor can be your go-to resource for years to come
They can help you with Medicare claims
They will help you get a better price than you might be able to find on your own
You will get non-biased opinion on all your Medicare options

Contact Susan Tighe for help today at (602)-705-1462! Susan lives locally and is focused on serving Yavapai County's seniors. As your local resource, she will guide you through your options.

Contact Susan