Teeth, eyes, and ears are the three things most people ask about when they first look at Medicare. The surprise is that Original Medicare mostly leaves them out. That does not mean you have no options. Here is what is covered, what is not, and how people handle the gap.
What Original Medicare covers
Original Medicare means Parts A and B. For these three areas, coverage is limited:
- Dental. Generally not covered for routine care like cleanings, fillings, extractions, root canals, or dentures. There are narrow exceptions, such as dental services needed as part of certain covered hospital procedures.
- Vision. Routine eye exams, eyeglasses, and contact lenses are generally not covered. There are exceptions, for example eyeglasses or contacts after cataract surgery, and some screenings for people at higher risk of eye disease.
- Hearing. Routine hearing exams and hearing aids are generally not covered, although diagnostic hearing and balance exams ordered by a doctor may be.
What Medicare Advantage often adds
Many Medicare Advantage plans include extra benefits beyond Original Medicare. Depending on the plan, these may include:
- Preventive and basic dental such as exams and cleanings, and sometimes fillings or dentures.
- Routine eye exams with an allowance toward eyeglasses or contacts.
- Hearing exams and an allowance toward hearing aids.
- Over-the-counter allowances and fitness memberships.
Benefits vary a lot. Some plans have low annual dollar limits, waiting periods, or networks that include only certain dentists, so a headline benefit might not match what you actually need. Always check the plan's specific details and confirm that your providers are in network.
Your options for coverage
- Pick an Advantage plan with the benefits you use. If you need dental work, look at annual limits and network dentists before enrolling.
- Add stand-alone dental, vision, and hearing insurance. If you have Original Medicare with a Medigap plan, you can still buy separate dental, vision and hearing coverage. Compare waiting periods, annual maximums, and networks.
- Use discount plans or local programs. These are not insurance, but they can lower out-of-pocket costs.
- Check other sources. Some people qualify for help through Medicaid or other programs depending on the state and income. Read about Medicaid and dual-eligible options.
- Pay out of pocket for routine care. Some people choose to save for these costs rather than buy coverage.
Compare plans by the benefits you actually use
Tell us what matters most — teeth, glasses, hearing aids — and we'll compare real plans at your address.
Get my free comparisonHow to decide
A useful way to think about it is to list what you expect to use in the next year:
- Do you have upcoming dental work such as crowns or dentures?
- Do you wear glasses or contacts, and when did you last update them?
- Have you noticed hearing changes, and would you consider hearing aids?
- Do your preferred dentist, optometrist, and audiologist take the plan?
Then compare total yearly cost: plan premium, copays, and what you would pay out of pocket for dental or hearing beyond the plan limits. A plan with a generous dental benefit but a restrictive network might cost you more than a plan with a smaller benefit that includes your dentist.
Common mistakes
- Assuming a benefit is unlimited because it is listed.
- Skipping the dentist's name check in the plan directory.
- Forgetting waiting periods for major dental work.
- Comparing only the monthly premium and ignoring the extras.
- Buying stand-alone coverage that duplicates what your plan already provides.
When to review
Benefits can change every year, so review your Annual Notice of Change each fall. If you rely on a particular benefit, read the ANOC carefully and compare alternatives before the December 7 deadline.
A note on cost in the real world
Dental, vision, and hearing costs are very personal. One person may spend little for years and then need a major procedure. Another may need new glasses and a hearing aid in the same year. If you tend to have large, lumpy costs, check the annual maximum and any waiting periods before you rely on a plan benefit. If you tend to have small, predictable costs, an allowance may cover most of what you spend.
Do not forget the fine print
Even good dental and vision benefits often have rules: a once-a-year exam, a once-every-two-years allowance for frames, or a requirement to use a specific network. Ask for the plan's summary of benefits, and read the dental, vision, and hearing sections line by line instead of relying on a marketing brochure.
How Honorbrook helps
We are an independent agency. We compare Medicare Advantage plans and stand-alone dental, vision, and hearing options from many carriers and match them to what you actually use. Our help costs you nothing, because carriers pay us and your premium is the same whether or not you use an agent.
Medicare help in your state
Honorbrook is licensed in the 11 states below. Plan availability, costs and some rules vary by state and county, so call us at (571) 354-0146 for what applies where you live.