As people enroll in Medicare, many forget to make note of its limits. While Medicare Part A covers emergency room situations, it’s a different story when it comes to covering vision and dental procedures. It is important to understand your options and what everything covers, so you’re prepared when your doctor or dentist prescribes treatments or schedules procedures. Here is an overview of the various Medicare Plans, so you will know how you’re covered for vision and dental treatments.
What Does Original Medicare Part A Cover?
Medicare Part A on its own will not cover basic dental services. This includes regular dental exams, cleanings, fillings, tooth extractions, and dentures. However, there are a few emergency situations in which Medicare might cover your dental treatment:
- If you have a problem with your jaw, Medicare Part A might cover the reconstruction of the jaw or a tooth extraction that is the result of a jaw injury.
- Medicare Part A will cover the hospital stay for a complicated dental procedure, but not the procedure itself.
- Medicare Part A might cover a preliminary dental exam if it’s required for certain medical treatments such as a kidney or heart transplant. This typically depends on who is performing the exam.
As you can see, these situations aren’t exactly Medicare dental plans, but rather other emergency treatments that happen to involve your teeth.
Medicare Part A also doesn’t cover eye exams, eyeglasses, or contact lenses. Since 75 percent of adults use some form of vision correction and nearly everyone uses their mouth regularly, most Medicare patients consider additional options to cover their dental and vision needs.
What Treatments Does Medicare Part B Cover?
While Medicare Part A is known for covering hospital and emergency room visits, Medicare Part B offers more of the traditional medical care that most patients need throughout the year. For vision plans, this includes testing for Glaucoma and Age-related Macular Degeneration (AMD).
Medicare Part B will also cover contact lenses and eyeglasses, but only after cataract surgery. This is because the eyewear is treated similarly to crutches or a wrap: it’s a medical device required after a procedure. However, there are some criteria you need to know beforehand.
- Patients are still expected to cover the 20 percent copay for the eyeglasses or contacts.
- Medicare will only cover your treatment, eyeglasses, and contacts if the supplier is enrolled in Medicare — even if you submit the claim.
- Patients will have to pay out of pocket for any non-covered services and any additional costs for upgraded frames.
It’s entirely possible that your doctor will recommend services that Medicare doesn’t cover. For example, they may order bi-annual eye exams to track degeneration or schedule follow-ups after a procedure. You will be required to pay this amount in full once you’ve exceeded the annual coverage.
Because dental coverage isn’t considered medically necessary to survive — though it can be incredibly painful when left untreated — Medicare Part B doesn’t cover dental either. If full dental and vision coverage are important to you, consider taking out a separate policy to cover basic dental, vision, and hearing (DVH) needs.
What Treatments Do DVH Plans Cover?
Plan benefits vary greatly just like any type of insurance. All plans with have waiting periods for some services. Identifying an affordable plan with minimal waiting periods and easy-to-use processes is key.
Opting into dental treatment might seem optional until you break a tooth and end up in excruciating pain. The same can be said with vision plans. Everything seems optional until you get that bill for your glasses.