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As you may know, Original Medicare covers many services and treatments it considers “medically necessary”. However, this term is vague. It can be unclear what falls into the medically necessary category and what does not.
One of the most common questions people have about Medicare coverage is about care for our eyes and teeth. So, how about it? Does Medicare cover eye and dental?
In this article we will answer that question for you in plain English.
Does Medicare Cover Eye and Dental?
The short answer to that is no. Generally speaking, Original Medicare does not cover routine dental or vision care. However, there are some conditions in which Original Medicare may provide some coverage for dental or vision care.
This includes emergency situations or those that are part of preparations for surgery. Let’s go into this in a little more detail.
Original Medicare Coverage
Medicare does not consider dental care to be a medically necessary service.
Most of the time, Original Medicare (Medicare Parts A and B) does not cover dental exams, procedures, or supply costs.
Additionally, eye exams, eyeglasses, and other vision related services are generally not covered by Original Medicare.
That said, Part A Coverage may help cover certain dental services while you are in the hospital.
However, Part B may support certain vision-related services in certain circumstances. This includes diagnostic eye exams, such as glaucoma tests and yearly eye exams to test for macular degeneration, cataract surgery, and prescription lenses or eyeglasses.
Other Options for Eye and Dental Coverage
But fear not, if you have Medicare and would like to receive some assistance with the costs of dental and vision care, you have several options.
You can enlist in a Medicare Advantage (Part C) plan that includes dental and vision benefits. This may give you access to routine dental and vision coverage.
Part C Coverage for Eye and Dental
Supplemental coverage for dental and vision care may be available through Medicare Advantage (Part C) plans. These plans offer additional coverage in addition to providing the same benefits as Original Medicare.
Many plans also include prescription drug coverage, as well as additional benefits such as hearing health coverage and gym memberships.
Keep in mind that Medicare Advantage plans are offered by private insurance companies to people who are eligible for Medicare.
The plans that are available to you are determined by your geographic location. The specific dental and vision services that are covered, as well as the cost of those services, will vary from plan to plan.
How To Find a Medicare Advantage Plan
Medicare Advantage plans are available in a variety of configurations, including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). The type of plan you have may have an impact on which dental or vision providers you are able to visit within your plan’s network of providers.
Pre-enrollment research should be done to ensure that your preferred dentist or optometrist is included in the plan’s network before enrolling in the plan.
Do your research and speak with a licensed insurance agent who can assist you in locating Medicare Advantage plans in your area that may provide dental and vision coverage.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare Cover Aquablation?