Seniors have teeth, ears, and eyes. But does Medicare cover them? Don’t miss this list to make sure you get the most bang for your buck! Plus, *special tip* — don’t fall into the “discount” trap!
When I ask clients (who we like to call “Members” here at My Medicare Partners) if they are satisfied with their Medicare plan, I consistently get the same complaint from folks: “Medicare doesn’t cover my dental, vision, and hearing care and I need coverage!”
They’re right. Medicare is greatly lacking in its coverage of teeth, ears, and eyes.
Does Medicare Cover Dental, Vision and Hearing?
Unfortunately, both Original Medicare and MediGap beneficiaries do not receive dental, vision, and hearing coverage through their Medicare plan. Also, while some purport to do so, Medicare Advantage plans cover very little benefit for dental, vision, and hearing (DVH) care.
Did You Know: Nearly half of Americans have no dental coverage? People cite “lack of insurance” as the main reason they don’t visit the dentist regularly. Regular dental screenings can help prevent tooth loss and decrease your risk of heart attacks and stroke.
Believe it or not, Medicare falls short in providing coverage for dental, vision, and hearing. It’s crazy to think that such a robust and widely used health care program is lacking, but alas, it is. Whether you have Original Medicare only or a Medicare Supplement plan, you are without coverage unless you purchase a separate plan.
Some Medicare Advantage, or MA, plans purport to cover DVH benefits, but most beneficiaries will caution you that these benefits offered by MA plans are very limited.
“Essentially, the DVH coverage in my Medicare Advantage plan is non-existent,” said one of my Members leaving her MA plan for a Supplement plan.
Having a robust DVH plan isn’t just about having pearly whites or accentuating your eyes. Glaucoma, easily detected through a routine eye exam, is the leading cause of blindness! Oral care is linked to heart disease! Hearing loss can be detrimental to a senior’s quality of life and independence!
Enrolling in both a DVH plan and a MediGap plan ensures you have the most flexibility and convenience of any options. Taking care of your mouth, eyes, and ears is part of holistic health care.
Did You Know: Men are more likely to experience hearing loss than women. Fewer than ⅓ of seniors who could benefit from hearing aids have ever used them. High costs are one of the reasons why many seniors don’t have access.
Be sure to find a plan with little to no waiting periods that you can afford and that helps you save on out of pocket costs. Buying a DVH plan can be confusing; it’s good to read these tips for finding a great DVH plan.
#1: Time things right
Many ancillary insurance (insurance that is secondary or covers other types of services not covered by medical insurance) plans have waiting periods for certain procedures, and dental plans are no different. Many dental plans have six to 12 month waiting periods… Meaning that you shouldn’t wait until toothaches arrive to enroll in insurance!
Most dental plans allow basic cleanings and x-rays during the waiting period. But more invasive procedures such as fillings, crowns, and extractions are sometimes not covered by a plan until the waiting period ends.
My Medicare Partners proudly offers dental insurance with no waiting periods for nearly all of your dental needs. Routine care is included as soon as coverage begins!
Vision and hearing plans may also have waiting periods. While waiting periods do vary from plan it plan, it’s important to get DVH coverage before you think you need it! You don’t want to be stranded when you need the coverage the most. Look for a plan (like the DVH plans My Medicare Partners offers) that have short waiting periods or don’t exclude many procedures during the waiting period.
#2: Make sure preexisting conditions are not excluded
Believe it or not, but some DVH plans refuse to cover “preexisting conditions” that a person acquired before the insurance coverage began.
This could result in claims being denied to cover a crown that was already cracked or a hearing aid that was already falling apart. Some plans only exclude preexisting conditions during the plan’s waiting period. Other plans exclude all preexisting conditions that would otherwise be covered by a plan.
If you are concerned about preexisting conditions being covered, speak with an Agent and find out if the plans they offer exclude preexisting conditions and which ones.
#3: Check the network
Just like with Medicare Advantage plans, many DVH plans have limited networks of providers who enrollees may visit to have their services covered. Restrictive networks can be tough to navigate, especially if you live in a rural area or do not have reliable transportation.
Some DVH plans, including the ones My Medicare Partners offers, don’t have any networks! This means you can go to any dentist, eye doctor, or ear doctor anywhere in the USA and your services will be covered!
My Medicare Partners believes in offering you the ultimate convenience — therefore our DVH plans are just like our Medicare Supplement plans: go to any doctor, any time, without referrals!
Some providers only accept certain kinds of dental, vision, and hearing insurance. Find yourself a plan that allows you to see any provider, regardless of the insurances a particular provider accepts!
#4: Know who pays
DVH plans are quite different than Medicare and Non-Medicare health insurance plans. Depending on which type of plan you have, you may either pay a fixed amount, pay a percentage, or be reimbursed after paying in full. There are several variations of DVH plans:
Some plans are similar to traditional health insurance, in that they are either HMOs or PPOs. This means that these plans pay the providers directly and that the beneficiary (you) pay a set amount when receiving services. These set amounts may be co-pays or coinsurance, and sometimes deductibles need to be met as well before procedures are covered.
For example, an HMO plan may require you only see providers on the plan’s list (also known as a network), may require a $200 annual deductible be paid out of pocket before services are covered, and may require a $25 co-pay for the office visit after the deductible is met. As you can probably guess, HMO and PPO dental, vision, and hearing plans often result in higher out of pocket costs – plus headaches! – with the many layers and restrictions they have.
*SPECIAL TIP!* Other DVH plans may be discount plans. These are not true “insurance” plans. Instead, the beneficiary (you) pays a negotiated rate or percentage of a procedure to the provider. Discount plans almost always also have limited networks of providers who accept their plans. Many discount plans also have long waiting periods. Discounts on certain procedures may have different levels of discount.
For example, an eyeglass exam may be covered 60% / 40% (meaning you pay 40% of the cost while the plan pays 60%), but contact lens exams may only be covered at 30% / 70% (which means a more expensive exam for you).
Discount plans also typically offer a large range of discounts, sometimes as low as just 5% off the full price of a procedure or service. A small percentage off of an expensive bill, such as one for hearing aids or for serious oral surgery, is just a drop in a very big bucket! Be careful not to fall into the dental discount plan trap!
Lastly, some plans are indemnity plans. Indemnity plans typically offer the most flexibility: they allow you to visit any provider. When covered by an indemnity plan, you pay upfront at the time of service for the procedures. Then, the plan reimburses you for all or part of the costs you paid after a claim is filed.
On the other hand, some plans reimburse the provider directly and you simply pay a co-pay for services received. These are also known as fee-for-service plans and often provide the most cost savings.
#5: Determine the level of coverage you need
DVH plans almost always have a “maximum allowable amount” or “maximum benefit” which determines how much the plan will cover in a given year. People who are expecting to need a lot of dental, vision or hearing care are encouraged to go with a plan that has a higher maximum benefit. Most plans offer two levels of coverage: $1000 and $1500.
For example, a plan with a $1,000 maximum benefit will provide coverage to you while your spending remains under $1,000 during the year. If you have a procedure done in August that cost $2300 and you have no deductible to pay, your billed amount would be the remaining amount the plan doesn’t cover of $1300.
Once a person meets their maximum benefit amount, they will not be covered by the DVH plan until the new Calendar year begins. In the example above, once this person reach their maximum allowable amount in August, that person will no longer be covered by their plan and will have to pay full price out of their own pocket!
#6: Know if Benefits Increase or Change
Most DVH plans like to reward loyalty by making the benefits better before the next year’s plans are even released! In other words, the longer you have the plan, the healthier you’ll be.
For example, in Year I, a plan may offer 60% coverage of an item. In Year II, the plan may increase their benefit coverage to 70% , therefore decreasing out of pocket costs. In year III, the plan begins to pay 80% of services! Nice, right?
If your insurance or discount DVH company is making changes to your plan that affect you, you will be contacted by them directly via mail. Benefit amounts may change and costs may increase. If your plan changes, check with an Agent to see if the plan you already had is still the best plan for you.
Medicare is wonderful – but it’s not perfect. There are gaps in Medicare’s coverage which require seniors to seek out coverage to provide them total protection via an ancillary insurance plan, like a Dental, Vision, and Hearing plan.
Ancillary, or extra, insurance plans help prevent unforeseen disasters that could be painful, inconvenient, and expensive! Prevent pain in your body and in your wallet by enrolling in a DVH plan today.
It’s critical that Medicare beneficiaries get DVH insurance to ensure their out of pocket costs are controlled. My Medicare Partners is happy to offer our Members comprehensive DVH insurance plans that covers dental care and cleanings, eyewear and eye care, and hearing screenings and hearing aids. All of these benefits are covered at one low cost!
Did You Know: While 62% of US adults wear glasses, fewer than half of them receive vision screenings annually? Eye exams not only help you see better – they also help detect glaucoma, diabetes, high blood pressure, and more.
Best of all: Our dental, vision, and health insurance plans have no network. See any doctor you’d like! Plus, the benefits increase each year you’re on the plan! There are no health questions to answer and the plan is guaranteed to be renewed every year. Contact us today to learn more: 1-844-305-6169