By Dana Barrett
Does Medicare Cover Dental Services?
As we age, so does the condition of our teeth, eyesight, and hearing. Dental care can be expensive, especially crowns and bridges, which run in the thousands of dollars. Hearing aids and eyeglasses are also costly, so why are these vital services not covered by Original Medicare?
The Importance of Routine Dental Care
More and more evidence suggests tooth decay and gum disease can lead to a whole host of other health concerns such as cardiovascular disease and memory issues. Also, denture wearers with no natural teeth can struggle with nutritional deficiencies. A mouth full of cavities and gum disease can aggravate health conditions, including heart disease and diabetes.
Undoubtedly, a lack of regular dental care can delay the diagnosis of more severe health conditions, leading to expensive emergency department visits. Original Medicare only covers dental procedures if they fall within a strictly defined set of circumstances.
Medicare Vision and Hearing Care
Original Medicare doesn’t cover preventative services such as routine eye exams or the expense associated with purchasing eyeglasses or contact lenses. Medicare Part A covers specific eye procedures but only when there’s hospitalization for a condition with eye trauma.
Medicare Part B includes glaucoma screenings and cataract surgery, as these conditions are covered under the umbrella of “general health.” Part B Medicare also includes screenings and tests necessary for the treatment of macular degeneration and diabetes.
Older adults are prone to hearing loss; however, hearing exams and hearing aids are not included in Original Medicare. The only time a hearing evaluation is covered is if it’s a “hearing and balance exam” to diagnose another health condition such as vertigo or a balance disorder.
Legislative Changes to Medicare
The Social Security Act excludes routine dental, vision, and hearing services from Original Medicare unless they fall under a very narrowly defined set of circumstances.
The federal government has begun to acknowledge the importance of these screening procedures in health maintenance for Medicare recipients, and in 2019 Congress drafted and approved House Resolution 3 (H.R. 3).
H.R. 3 is intended to make changes to Medicare dental insurance and includes improvements in routine eye care and hearing coverage for Original Medicare (Part B) recipients.
Dental services, routine exams, x-rays and screenings would be covered under Part B benefits starting in 2025. Tooth extractions, fillings, and restorations would also be covered. Original Medicare recipients would still be required to pay the standard 20% as an out-of-pocket expense.
Dental procedures like root canals or dentures are also included but at a much lower rate. Under H.R. 3, the recipient would be responsible for 90% of the out-of-pocket cost but would drop down to 50% over several years.
Annual vision exams and hearing exams would become standard through Part B Original Medicare. A hearing aid purchase would also be covered under part B, with a 20% copayment. Additionally, there would be an $85 allowance towards the purchase of eyeglasses or contact lenses. Be aware H.R.3 isn’t approved yet. It is still waiting to be voted on in the Senate.
So how can I get these benefits from Medicare now?
The good news is that you can switch from Original Medicare to a Medicare Advantage plan (Medicare Part C) which offers extra coverage for these services. About 75% of Medicare recipients currently have Medicare dental insurance through a Medicare Advantage Plan. Many of these dental plans offer routine care, which can include:
- Annual exams
- Cleanings and X-rays
- The filling of cavities
- Root canal treatments
- Crowns and Bridges
- Dentures and Implants
Some plans only offer preventative services, while others include more comprehensive dental care. Coverage will be subject to annual limits.
Dental Discount Cards
Dental discount cards are another option to help offset the cost of dental services. These discount plans are available in most areas, and many major insurance carriers offer their own dental discount memberships for consumers instead of dental insurance. The goal of these programs is to provide immediate discounts for dental services at the time of your visit. Still, they can only be used within a network of participating providers.
It’s important to note that a dental discount card is not part of Medicare. The way the discount card plan works is a network of dentists who agree to charge fixed discounted rates for specific dental procedures covered by the program. Discounts average anywhere from 10% to as deep as 60% for most covered services.
To join a discount card plan you’ll pay an annual fee; however, these plans don’t require a deductible or copay and there is no annual out-of-pocket cap. The recipient must pay for dental services at the network rates and only with participating providers. You can check with your dentist to see if they are part of a discount plan network, or you can research dental discount cards online.
Medicare Advantage for Eye Care and Hearing
Most Medicare Advantage plan recipients enroll in vision care plans to help reduce the cost of purchasing glasses and contact lenses and have coverage for annual eye exams and fittings. The rates at which these services are covered differ between plans, so be sure to check the plan details when you enroll.
Around 75% of Medicare Advantage customers have hearing coverage. Suppose you’ve been referred to a specialist for a hearing problem. In that case, it makes sense to check with that provider to see which Medicare Advantage plan they accept before making changes to your Medicare Advantage coverage.
Hearing aids are also covered by Medicare Advantage and are available for different price ranges. Basic models typically run from $1,500 – $2,000, but more specialized devices can cost much more. Medicare Advantage plans that offer hearing coverage will cover some or all of that cost.
If you need assistance locating Medicare Advantage plans with the added services of dental, vision, and eye care in your area, press the link below and one of our representatives can help you.