Original Medicare does not cover most dental services. This includes cleanings, fillings, extractions, dentures, dental plates, and other devices. Eye exams for glasses or contact lenses are also not covered by original Medicare. You pay 100% out of pocket for these services. However, some Medicare Advantage Plans (Medicare Part C) offer benefits not covered by Original Medicare, which may include dental and vision services.
Are There Exceptions for Medicare Coverage of Dental Services?
Medicare Part C (hospitalization) will cover certain dental services delivered in the hospital. It may pay for inpatient hospital care for emergency or complicated dental procedures that would not otherwise be covered. As stated on Medicare.gov, inpatient care includes treatment at a critical access hospital, an acute care hospital, a long-term care hospital, an inpatient rehabilitation facility, or as part of a qualifying research study.
What Are the Exceptions Under Medicare for Vision Services?
Original Medicare does provide some eye care coverage for individuals with specific medical conditions.
Diabetes
If you have diabetes, Medicare Part B will cover eye exams for diabetic retinopathy once per year. The Part B deductible applies, and you are required to pay 20% of the cost of the doctor’s services (at the Medicare-approved amount). If the service is performed in a hospital outpatient setting, you will have a copayment.
Macular Degeneration
For people with age-related macular degeneration, Medicare Part B may cover certain diagnostic tests and treatments (including injected drugs) for diseases and conditions of the eye. Again, you pay 20% of the Medicare-approved cost of the doctor’s services and drugs, and the Part B deductible applies, as well as a copayment if the service is delivered in a hospital outpatient setting.
Glaucoma
If you are at high risk for glaucoma, Medicare Part B will cover a glaucoma test every 12 months. Risk factors for glaucoma include:
- Diabetes
- Family history of glaucoma
- Hispanic and age 65 or older
- African-American and age 50 or older
As with diabetes and macular degeneration, the Part B deductible applies to glaucoma testing. You pay 20% of the cost, plus a copayment if the test is performed in a hospital outpatient setting.
Do Medigap Plans Cover Dental and Vision Care?
Medicare Supplement Insurance, commonly known as Medigap, is designed to fill in the gaps or cover some of the out-of-pocket costs associated with original Medicare. This type of insurance does not cover vision or dental services.
How Can I Find a Medicare Advantage Plan With Dental and Vision Coverage?
Medicare Advantage Plans (Medicare Part C) are Medicare-approved health plans offered by private insurance companies. Many of these plans offer benefits beyond what Original Medicare provides, including dental, vision, and hearing services. There are tools available online that allow you to enter your zip code and compare Medicare Advantage Plans in your area. Be sure to check the providers participating in the plan’s network to ensure your eye doctor and dentist are included.
If you would rather have professional assistance than using an online tool, our friendly agents are here. We can help you find a plan that suits your healthcare needs, including dental and vision coverage.
