Dental, Vision and Hearing Coverage on Medicare

Medicare does not cover routine dental

Many people find this out at the dentist's front desk. In most cases, Original Medicare does not pay for cleanings, fillings, extractions, dentures or implants. It covers dental care only in a few cases, such as care needed before certain heart or transplant surgery, or some care during a hospital stay. A Medicare Supplement does not add dental either.

Some Medicare Advantage plans include dental benefits. You can also buy a separate dental plan. Either way, it helps to know how dental coverage really works before you count on it.

How dental plans really work

Will my dentist take it? Some plans let you see any dentist. Others pay more, or only pay, when you use a dentist in their network. If you have a dentist you like, that is the first thing we check.

Waiting periods. Many plans cover cleanings and checkups soon after you start. Bigger work like crowns, bridges or dentures often has a waiting period, sometimes six months or a year or longer. If you know you need work done, tell us up front.

Yearly maximums. Most dental plans have a limit on what they will pay in a year. After that, you pay the rest. One large job can use up the yearly maximum fast.

Missing tooth clauses. Some plans will not pay to replace a tooth that was missing before your coverage started. If you are missing teeth now, ask about this before you buy.

Preventive vs major care. Plans usually pay the most for preventive care (cleanings, exams, X-rays), less for basic care (fillings), and the least for major care (crowns, root canals, dentures). Read how much the plan pays at each level.

We read these details with you so a bill at the dentist does not catch you off guard.

Vision and hearing

Original Medicare does not cover routine eye exams for glasses, or glasses and contacts in most cases. It also does not cover hearing aids or exams to fit them. Some Medicare Advantage plans include vision and hearing benefits, and some dental plans bundle vision and hearing too. The benefits vary a lot, so we look at what each plan actually pays for before you choose.

Hospital indemnity

What it covers: A hospital indemnity plan pays you a set cash benefit when you are admitted to the hospital. Some also pay for other care, like an emergency room visit or a stay in a rehab center. The money goes to you, and you choose how to use it.

Who it fits best: People with Medicare Advantage who want help with hospital copays, which can add up during a stay. Each plan has its own rules about what counts and how much it pays, so read them closely.

Critical illness, cancer, heart attack and stroke plans

What it covers: These plans pay a lump-sum cash benefit if you are diagnosed with a covered illness, such as cancer, a heart attack or a stroke. You can use the money for anything, like travel to treatment, bills at home, or costs your health plan does not pay.

Things to know: The rules vary from plan to plan. Each one defines which conditions count, may have a waiting period, and may not cover a condition you had before you bought it. Read the policy before you buy.

Long-term care

This is a gap many families do not see coming. Medicare does not pay for long-term custodial care. That means help with daily tasks like bathing, dressing and eating, at home or in a nursing home. Medicare may cover a short stay in a skilled nursing facility after a qualifying hospital stay, but not ongoing care.

There are options. Short-term care plans can help pay for care for a limited time. Long-term care insurance and some life insurance policies with care benefits can help over a longer period. Each works differently, and what you can buy depends on your age and health. We can talk it through with you, with no pressure.

What you pay

Prices for these plans depend on the plan, your age, where you live, and sometimes your health. We show you the price for each plan we offer before you decide, and the price is the same with us as going direct.