One of the most common surprises for new Medicare beneficiaries is discovering the gaps in coverage for routine care. You may have had employer-sponsored health insurance for decades that included benefits for dental, vision, and hearing. It is a reasonable assumption that Medicare, our nation’s health program for seniors, would also cover these essential services.
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Unfortunately, this is not the case. Original Medicare (Part A and Part B) was designed primarily for hospital and medical services. It does not cover most routine dental, vision, or hearing (DVH) care.
This leaves many beneficiaries facing significant and unexpected out-of-pocket costs. But do not worry—you have several excellent options to get the comprehensive coverage you need. This guide will walk you through what Medicare covers and how you can fill these critical gaps.
What Original Medicare Covers and Does Not Cover
Original Medicare is a powerful health insurance program, but it is important to understand its specific focus.
Medicare Part A (Hospital Insurance) helps pay for inpatient care in a hospital, skilled nursing facility care, hospice, and home health care.
Medicare Part B (Medical Insurance) helps pay for doctors’ services, outpatient care, medical supplies, and preventive services.
Here is what Original Medicare generally does not cover:
- Routine dental exams, cleanings, and fillings
- Dentures, dental plates, or other dental devices
- Routine eye exams for glasses or contacts
- Eyeglasses or contact lenses
- Hearing exams
- Hearing aids
When Medicare Does Cover Dental, Vision, or Hearing
While Medicare does not cover routine care, it will cover DVH services if they are considered “medically necessary.” These situations are exceptions, not the rule.
- Dental Coverage: Medicare Part A may pay for certain dental services that you receive while in the hospital. For example, if you have an accident that damages your jaw, Medicare may cover the reconstruction. Part B may also cover a dental exam if it is required before a major procedure, such as a kidney transplant or heart valve replacement.
- Vision Coverage: Medicare Part B helps cover some diagnostic and preventive vision tests. This includes a yearly glaucoma screening for those at high risk and annual exams for diabetic retinopathy. Part B will also cover surgery to remove cataracts, including the cost of the standard intraocular lens.
- Hearing Coverage: Medicare Part B covers diagnostic hearing exams if your doctor orders them to determine if you have a medical condition causing hearing loss. However, it explicitly does not cover hearing aids or the exams to fit them.
Paying Out-of-Pocket Costs: What You Can Expect
Without dedicated DVH coverage, the costs can add up quickly. These services are often far from inexpensive.
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According to dental associations, a single dental crown can cost between $800 and $2,500 without insurance. A full set of dentures can cost thousands. When it comes to hearing, the financial impact is even greater. The National Institute on Deafness and Other Communication Disorders (NIDCD) notes that hearing aids can be very expensive. Consumers can expect to pay anywhere from $2,000 to over $7,000 for a pair.
Facing these costs on a fixed income is a serious challenge, which makes finding the right supplemental coverage a priority.
Medicare Advantage (Part C) Plans: What They Offer
Medicare Advantage (MA) plans are one way to get DVH benefits. These plans are offered by private insurance companies and bundle your Part A, Part B, and often Part D (prescription drug) coverage into one “all-in-one” plan.
A vast majority of MA plans—over 97 percent according to a KFF analysis—offer some level of dental, vision, and hearing benefits as a way to attract members.
However, these benefits come with trade-offs. MA plans operate using provider networks (like HMOs or PPOs), which means you must use their approved doctors and dentists. Furthermore, the DVH benefits often have low annual coverage caps. A plan might offer a $1,500 annual allowance for dental care, which can be exhausted by a single procedure, leaving you to pay the rest.
Comparing Original Medicare + Medigap vs. Medicare Advantage
This brings us to a crucial choice every beneficiary must make.
- Medicare Advantage (MA) bundles your medical and extra benefits (like DVH) into one plan, but it limits your provider choice to a local network and has higher maximum out-of-pocket limits for medical care.
- Original Medicare + a Medicare Supplement (Medigap) plan is the other path. A Medigap plan works with Original Medicare to pay for your coinsurance and deductibles.
The most significant benefit of the Medigap path is freedom and predictability. With Original Medicare and a Medigap plan, you can see any doctor or visit any hospital in the United States that accepts Medicare. You are not restricted by a network. Your out-of-pocket costs for medical services are extremely low and predictable, which is the hallmark of Medigap coverage.
While Medigap plans do not include DVH benefits, they provide a stable and comprehensive foundation for your core medical needs. You can then easily add the DVH coverage you want separately.
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For a deeper look at these two paths, you can read our guide: Medicare Supplement (Medigap) vs. Medicare Advantage.
Standalone Dental, Vision, and Hearing Insurance Options
If you choose the stability of Original Medicare and a Medigap plan, you can purchase separate, standalone insurance policies for dental, vision, or hearing.
This “a la carte” approach offers tremendous flexibility. It allows you to build the exact coverage you want without compromising on your medical plan. You can choose a robust dental plan that covers crowns and implants and a separate vision plan that gives you a generous allowance for glasses, all while keeping the freedom of your Medigap plan. This combination is often the best way to ensure you have comprehensive coverage for every aspect of your health.
How to Shop Smart for Coverage
When evaluating standalone or Medicare Advantage DVH benefits, look beyond the low premium. Ask these important questions:
- What is the annual maximum? How much will the plan pay for your DVH care in a single year?
- What are the copayments and coinsurance? What percentage of the bill will you be responsible for?
- Is there a deductible? How much must you pay before the plan’s coverage begins?
- Are there waiting periods? Will you have to wait several months before the plan will cover major services like a root canal or bridge?
- Which dentists, audiologists, and optometrists are in the network? Is your preferred provider on the list?
When to Enroll and When You Can Switch Plans
You may enroll in stand-alone dental, vision, and hearing coverage at any time throughout the year.
Important coverage decisions, including choosing a Medicare Advantage, can be made only during certain times of the year called enrollment periods.
- Initial Enrollment Period (IEP): This is the seven-month window when you first become eligible for Medicare (three months before your 65th birthday month, your birthday month, and three months after). This is the best time to enroll in Part A, Part B, and a Medigap plan (with guaranteed issue rights).
- Annual Enrollment Period (AEP): From October 15 to December 7 each year, all beneficiaries can make changes. You can switch from Original Medicare to a Medicare Advantage plan, switch from MA back to Original Medicare, or change MA plans.
- Medicare Advantage Open Enrollment Period (MA-OEP): From January 1 to March 31 each year, if you are already in an MA plan, you have a one-time opportunity to switch to a different MA plan or drop it and return to Original Medicare.
It is important to note that if you leave a Medicare Advantage plan and return to Original Medicare outside of your initial Medigap open enrollment window, you may have to go through medical underwriting to be approved for a Medigap plan.
You can learn more in our detailed guide to Medicare Enrollment Periods.
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