Original Medicare Does Not Cover Basic Services for Eyes, Ears, and Teeth
Did you know that Original Medicare doesn't include routine dental, vision, or hearing care? Just as some employers ask employees to elect dental or vision coverage as a separate line item, Original Medicare works in a similar way.
If you’ve ever awoken to a toothache, use hearing aids, or need glasses, you know these benefits play an important role in your quality of life and peace of mind. To address this gap in coverage, private insurance carriers offer add-on coverage that compliments your Medicare Supplement, Advantage (if it’s not included) or Original Medicare plan. Dental, vision, and hearing coverage is often grouped together and is sometimes referred to simply as “DVH”. Individual plans vary in cost, ranging from about $35 to $75 a month.
When considering your approach to Medicare, never forget to consider your dental, vision, and hearing needs. Below are the most important factors to make sure a DVH plan is a good fit.
Most plans don't allow enrollees to use the services right away. Waiting periods can vary from three to 12 months before the policy becomes active. Additionally, some benefits may require a waiting period, even after the plan is active. For example, a plan may offer an annual hearing checkup and two annual teeth cleanings as soon as you sign up. However, that same plan may make you wait six months before replacing your hearing aid, and a year before coverage for fillings and crowns kicks in. The key is to secure coverage before you need it. Don’t wait until an urgent need arises before signing up.
If you’ve had employer-based insurance, or had a Medicare Advantage plan, you're likely familiar with provider networks. The “network” includes the physicians, hospitals, clinics, and specialists you can see while paying the smallest copay. This means going out of your network will cost more or may not be covered at all. Some plans don't use networks and cover the charges included in the policy no matter which professional you see.
Medicare does not dictate what dental, vision, and hearing insurance must cover. As a result, the items covered by different policies can vary significantly. Compare plans based on these variables:
Maximum Benefit (also called a “maximum allowable amount”)
This puts a limit on how much the plan will pay annually. The higher the limit, the higher the premium you will pay for the policy. If you anticipate needing extensive treatment, a higher limit may be to your advantage.
Policies often entice you to renew your membership by increasing coverage the longer you stay in the plan. Your first year, you may receive 70% of the cost of your contact lenses, 80% next year, and 90% the year after that. Your out-of-pocket costs go down when you renew your policy.
Dental, vision, and hearing policies may exclude pre-existing conditions. This means the insurer may refuse to cover replacement lenses or a new crown, for example, if the old ones were cracked before you started coverage.
Depending on the plan, your costs can include some or all the following: premiums, deductibles, and copays. If you will be making several visits to the dentist, eye doctor, or ear doctor throughout the year, you may prefer to pay a higher monthly premium in exchange for lower copays and deductibles. A lower premium may be the way to go if your eyes, ears, and teeth are in relatively good shape and you can handle a larger copay if an unexpected need pops up.
With so many options and variables, working with United Medicare Advisors can make your research and selection simple and stress-free. Don't let confusion hold you back from getting the coverage you need. Speak with us today about switching or enrolling in your first plan.
Published: January 1, 2020