Number 1. Dental work services
Medicare doesn’t cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.
Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you’re in a hospital. Part A can pay for Inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isn’t covered.
Your costs in Original Medicare:
You pay 100% for non-covered services, including most dental care.
Number 2. Eye exams (routine)
Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses.
Your costs in Original Medicare:
You pay 100% for eye exams for eyeglasses or contact lenses.
Number 1 & 2 are the exact explanations word for word on the Medicre.gov site regarding coverage for dental and eye exams. Someone may read these explanations and walk away with the thought that they can’t get coverage over the age of 65 when in fact there are several ways, including getting covered under most Medicare Advantage plans.
It seems over the last two or three years I’ve been getting more and more inquiries regarding dental and vision plans than ever before. Let me start off by saying that cataracts and glaucoma ARE covered under Medicare because both are considered “medical conditions.”
When I explain that to some folks I sit with, it sometimes draws a big sigh of relief because at some point either they’ve had issues or someone they know has had issues and it could get costly if those conditions were not covered under Medicare.
I already talked earlier how routine dental and vision are not covered under Medicare. That means if Original Medicare does not cover them, then your Medigap plan will not cover them either.
At BGA Insurance Group one of the plans we specialize in is additional dental and vision coverage, completely independent from your Medicare.
The great bonus about purchasing one of these plans are, they are not expensive and virtually no health questions are asked. The application process is very easy, and you can be covered almost immediately. I sell two different carriers, one is Medico and the other being Mutual of Omaha.
Medico has a few different options, one is just basic dental, one is dental and vision, and the third one covers you for dental, vision, and hearing. There are different levels of benefits and when they are covered. For example, if you need a crown, there is a 12-month waiting period, meaning you need to be a Medico customer for at least a year before that particular benefit is covered.
However, if you need “preventative services” such as cleanings or x-rays there is only a three-month waiting period and is covered 100% under the “dental only” plan.
On their vision plan there is no waiting periods for an exam, and it does pay towards some hardware such as glasses and frames.
The biggest pro about purchasing a Medico plan is that there is no network, meaning you can see any licensed dentist or any licensed eye doctor you wish to see. You do not need to check if your doctor accepts Medico or not, you have freedom of choice with their plans.
The other plan I carry is becoming more and more popular as the months go by and is sold by Mutual of Omaha. They have two different plans to choose from depending on the level of benefits you wish to purchase, and the monthly premium you want to pay.
Unlike the Medico plans this is a network coverage plan meaning you need to see if your dentist does in fact accept the insurance. You can see a dentist outside the network but in most cases, you will pay more than if you use a network doctor.
The big pro this plan has going for it is, there are NO waiting periods for preventative or diagnostic services. So, if you purchase the plan you can have an x-ray or cleaning immediately. Another big factor why people like this plan is that if you need dental implants they are covered under the “Lifetime Maximum Benefit”.
So, you don’t have Original Medicare, but you have a Medicare Advantage Plan?
If you noticed, most Advantage plans now participate in the “Silver Sneakers” program.
Well now most Advantage plans also carry “preventative” dental and vision benefits. Guess what? You have an HMO and now you can get a free cleaning every six months or an x-ray.
That’s great but don’t confuse those preventative benefits with thinking your dentures or fillings are covered. I sell a lot of Aetna and Independence Blue Cross plans and find that those preventative benefits are a nice add-on to their coverage. However, I still get the questions as to whether caps, crowns, implants etc. are covered.
Those benefits do not qualify under preventative benefits. Independence Blue Cross decided to extend some of those benefits under additional coverage plans you can purchase for a low monthly premium. They have two options, and both are very affordable. Their “Choice Plus” option covers dental, vision and hearing.
Although it does not cover dentures or major surgery such as root canals, it does pay a very nice benefit of hearing aids and vision hardware.
I can sit here and go on and on about what benefits are covered and when are they covered, but that is an explanation of benefits you will want to hear from your licensed BGA Insurance agent.
Just know this, almost 40% of United States adults over the age of 65 have lost 6 or more teeth due to tooth decay or gum disease. More than 90% have had a cavity and nearly 50% of all adults aged 30 and over have signs of gum disease.
Good oral health will protect your smile and your budget and lead to an improved quality of life. Have you ever had a toothache? Or worse, have you ever had to sit through a root canal?
Staying on top of your dental needs could prevent the painful, inconvenient and expensive option.
Finding the right plan can be complicated for some folks, so get with your BGA agent to choose among several options to fit your needs.
Written by Joe Bachmeier, BGA Insurance Group Co-Founder