Medicare Eye Care And Vision Benefits
Medicare Part B provides a number of eye care and vision benefits. Keep in mind that there are premiums and deductibles associated with Medicare Part B.
According to Medicare.gov :
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The standard premium for Medicare Part B in 2020 is $144.60 per month. Your monthly premium may be higher depending on your income, but most people who receive Social Security benefits will pay less than this amount.
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The annual deductible for Medicare Part B in 2020 is $198. After you spend this amount, you typically pay 20 percent of the Medicare-approved amount for most doctor services, outpatient treatments and durable medical equipment.
Here is a list of some of the eye care benefits of Medicare:
Care Costs Less When You Use A Network Dentist
In a DHMO, youre only covered when you see a network dentist. But what about a DPPO? Even though you go can outside of the network, its almost always worth your while to see a network dentist because youll get the PPO discount: insurance companies negotiate discounted fees on your behalf, and the savings can be substantial . For example, if your dentist typically charges $100 for a particular treatment, with the discount, you may only be charged $60-$70.
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Best For Potential New Offerings: Wellcare
WellCare
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Only available in 27 states
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Not as established as some other providers
Founded in 1985, WellCare is a relative newcomer. We picked them as one to watch for potential new offerings in their Medicare Advantage Plans for two reasons: In 2018, WellCare acquired Aetnas Part D prescription drug plan and in 2020, they were acquired by Centene, one of the largest providers of Medicaid. This deal-making activity could result in new Medicare Advantage Plan offerings that address specific pricing or feature needs.
Benefits offered with some WellCare Medicare Advantage Plans include over-the-counter coverage and access to a personal emergency response system. The OTC benefit is a fixed dollar amount for non-prescription medications and wellness-oriented items that can be shipped directly to you. The personal emergency response system, for people who live alone or are left alone for long periods, is connected to your phone and allows you to get emergency help with the push of a button.
WellCare Medicare Advantage Plans are available in 27 states. They have a full range of plans with premiums ranging from $0 to over $100 each month, depending on your needs and location.
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Which States Have Limited Adult Dental Coverage
When Medicaid has limited coverage for dental, this usually means one of two things. Either there is a financial cap to the dental care you can have covered, or there is a fixed list of services that will be covered.
If it is a financial cap, the range is usually somewhere between $500 to $1000. Once that amount is met, dental wont be covered unless it is an emergency.
If it is a fixed list, your Medicaid dental benefits will typically include preventative care such as cleanings and restorative care such as fillings, as well as emergency care.
States with limited adult dental care:
- Arkansas
- Washington
- Wisconsin
Something that is not typically covered even in comprehensive plans is adult orthodontic care or braces. If this is something that you require, you may need to pay out-of-pocket. Luckily, this is not something that would be an emergency, so you will still have all the care that you need to maintain good dental health.
Why Do I Need Dental And Vision Insurance
Older adults are seven times more likely to develop oral cancer, which could be prevented by maintaining regular dental care. The possibility for other problems, such as gum disease, a risk factor for heart disease, also increases nearly 50 percent for individuals over the age of 65. Even dry mouth, a seemingly benign condition, can lead to more cavities, infections, and sores.
Routine dental care has the power to detect and prevent most of these issues. Nevertheless, dental care is rarely cheap. Basic cleaning and exams cost $150-$350 on average, and more complex procedures like bridges and implants can easily make a single dental visit cost over $1,000.
Per the American Optometric Association, adults over 61 years old should receive an eye exam once per year. Thats no surprise since approximately one in three individuals has some type of vision-reducing eye disease by age 65. Plus, many eye conditions, such as diabetic retinopathy, macular degeneration, and cataracts, are age-related and most treatable if dealt with early.
Unfortunately, vision care is hardly more affordable, with the average eye exam costing between $150 and $200. And the average price tag for basic single lens glasses at an eye doctor or independent eyeglasses shop is nearly $400 without insurance.
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Health First Colorado Partners With Dentaquest
Health First Colorado has partnered with DentaQuest to help our members find a dentist and help us manage our members’ dental benefits. All Health First Colorado members will receive member identification cards along with a welcome packet from DentaQuest with information about your dental benefit coverage, how to use your dental benefits, and where to get information if you have questions.
DentaQuest operates a customer service center to specifically answer Health First Colorado members’ dental questions. DentaQuest’s Member Services is available Monday through Friday between 8 a.m. and 5:00 p.m. Mountain Time at: 1-855-225-1729, TTY: 711, or at DentaQuest.com.
Supplemental Dental Insurance For Seniors On Medicare
Seniors and Medicare eligibles may not find the oral health coverage they need with Medicare Advantage or Medicare Supplement plans. For example, a Medicare Advantage plan might cover routine dental services , but not major services like dental implants.
Medicare Supplements are private plans that cover financial items like Original Medicare copays and coinsurance. With a Medicare Supplement plan, you pay a monthly premium and you dont pay a separate copay or coinsurance when you visit the doctor*.
You cannot have both a Medicare Advantage and a Medicare Supplement plan at the same time. Its important to know how each type of plan can save you money. Contact your agent to discuss the difference between each type of plan, and ask how you can save money with each. Talk to your agent about your dental care needs, too. Your agent may be able to find a plan in your area that meets your budget needs along with your medical needs.
If you need additional coverage, you may be able to find private dental insurance plans that cover items such as dental implants, cosmetic dentistry, or orthodontics. Private dental plans, like Medicare Advantage plans, may be available as a dental PPO, HMO, or other plan type.
*Plan benefits can vary by plan. Some Medicare Supplements cover copays for doctors appointments. Medicare Supplements only help cover Medicare-approved charges.
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Medicare Advantage Dental Coverage
A Medicare Advantage plan with dental coverage may offer benefits that could include:
- Routine dental exams
- Bridges
- Crowns
The specific coverage offered by your plan may not include all of the items listed above. Check with your plan carrier to learn more about the terms of your Medicare Advantage plan dental coverage.
Does Medicare Pay For Dentures
If denture or dental implant coverage is important you, then you should consider a Medicare Advantage plan as dental insurance for seniors.
Medicare Advantage plans provide Part A and Part B plus additional coverage like prescription drugs, vision, hearing, and dental health!
Most Medicare Advantage dental plans cover dentures and much more cleanings, x-rays, annual exams, fillings, pullings, and root canals.
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Spending And Coverage Categories
The MCBS creates general categories of spending across services such as inpatient, outpatient, and medical provider . Use of dental services constitute one such service category. To calculate spending related to vision, and hearing services, we were able to identify use and spending related to optometrist services or to the purchase of eyeglasses and use and spending related to audiologist services or to the purchase or repair of hearing aids . All total costs are also separated by payerincluding private insurance, Medicare, Medicaid, and out-of-pocket spending.
Coverage of dental, vision, and hearing services was constructed from and limited by the information available through the MCBS for people in traditional Medicare. We were able to complement the self-reported information with MA plan benefit data for those enrolled in MA plans. The questions in the MCBS are limited to self-reports of dental and vision coverage. As there are no stand-alone plans available for hearing aids or services, the survey does not ask about them. To account for the coverage of hearing care that exists through some state Medicaid programs, we assumed that Medicare beneficiaries who were dually enrolled in Medicaid and lived in states that covered hearing care as a state benefit in 2016 had hearing coverage.29
Additional Free Dental Care Services In Mississippi
The Mississippi Dental Lifeline Network can be contacted for more information. Whether it is to get information on another local dental clinic near you, or to learn about Medicaid and if it pays for cleanings or some other service, dial 888.235.5826. There are many centers in Mississippi that offer free cleanings to children, fluoride treatment, and much more.
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Care Coordination And Disease Management
Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. Sunflower Health Plan pays for these services. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more. Call Customer Service at .
Interested in quitting a tobacco habit? We have resources available to help. For KanCare members, there is now an expanded benefit available, just for you.
What Does The Dental Benefit Cover
See the Children’s Dental Benefits page for more information about benefits for Health First Colorado members under age 21.
The adult dental benefit is available to eligible adult Health First Colorado members and covers:
- Annual dental exams and cleanings
- Diagnostic and restorative dental services
- Extractions
- Other procedures requiring *prior authorization are also available.
Emergency services and dentures are not subject to the $1,500 limit per state fiscal year.
The replacement of lost, stolen, or unrepairable broken dentures are an once per member lifetime benefit.
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Does Medicare Cover Vision Care
Vision care is not seen as medically necessary, so Original Medicare doesnt cover eye exams, eyeglasses or other related vision services.
However, Medicare Part B may cover some things for vision including preventive or diagnostic eye exams, including glaucoma tests, yearly eye exams to test for diabetic retinopathy and eye tests for macular degeneration, cataract surgery and prescription lenses or eyeglasses in certain situations.
But fear not, you have options if you have Medicare and want some help with the cost of dental and vision care. Learn how to get dental, vision and hearing care covered when choosing Medicare in the video below.
How Will The Biden Medicare Dental Plan Affect The Trust Fund Solvency
Retiree at the dentist
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Among the changes coming if the Democrats succeed in their $3.5 trillion reconciliation bill would be the inclusion of dental, vision, and hearing coverage through Medicare, possibly in 3 5 years due to implementation challenges, and with suggestions of a voucher/cash payout in the meantime. There is not yet an official cost estimate as the details are still being negotiated, but a similar proposal in 2019 would have cost $358 billion over 10 years.
At the same time, late last month, the latest Trustees Report for Medicare determined that the Medicare Part A Trust Fund will be exhausted in the year 2026, which, if you do the math, is a mere five years from now. At that point, Medicare would have to cut reimbursement rates for doctors by 9%, increasing to 20% in 2045, or even more if the reports assumptions dont pan out.
How will the new dental benefits assuming they remain in the bill affect Medicare Part A and its trust fund? Strictly speaking, not at all. The new benefits would be a part of Part B of the program, that is, doctors charges, rather than Part A, which covers hospital charges. In one respect, it would be its own benefit structure entirely, since, unlike regular Part B Medicare, the proposal would have the federal government pay 100% of the benefits costs, rather than requiring participants to pay a 25% cost-share premium. It would, in a way, become Medicare Part E.
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Eligibility For Medicaid Vision Coverage
More than 70 million Americans receive health care coverage through Medicaid, which provides health insurance and care to eligible citizens. Under federal laws, Medicaid must be offered to the following
- Low-income families typically those at or below 133 percent of the federal poverty line
- Qualified children and pregnant women
- Individuals with disabilities, which includes blindness
- People receiving Supplemental Security Income
Each state has their own Medicaid program, and benefits can be expanded beyond these basic parameters to include more people, such as low-income adults. Preventative care through Medicaid includes checkups, which should also include a vision screening.
Vision screenings can help to recognize a potential issue. You can then be referred for additional diagnostics and exams.
Children using Medicaid automatically qualify for these vision services through federal guidelines, and each state can determine the extent of vision coverage for adults. Your doctor can help you determine what services are covered and at what amount.
Typically, Medicaid offers services for free or at a reduced cost. While there is no charge for most services for children, there may be a small copay for adults using Medicaid services.
Nat Gen Hearing Coverage
Nat Gen hearing coverage will pay up to $125 on diagnostic services including hearing exams. It will also save you an average of 62% on hearing devices. Some additional perks include a year of free follow-up care, two years of free batteries, and a three-year warranty for loss, repairs, or damage to hearing devices.
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Find A Medicare Advantage Plan That Covers Dental And Vision Care
Medicare Advantage plans can come in a variety of types, such as HMOs or PPOs.
The type of plan you have may affect which dental or vision providers you can visit in your plan network. Before enrolling in a plan, its wise to check the plans network participants to see if your favorite dentist or optometrist accepts the plan.
Compare Medicare Advantage plans in your area
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
1 Fugelsten Biniek, J. et al. . Medicare Advantage 2021 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2021-spotlight-first-look.
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
B Late Enrollment Penalty
If you do not sign up for Medicare Part B when you first become eligible but later decide to enroll, you may have to pay a late enrollment penalty for as long as you remain enrolled in Part B.
The late enrollment penalty for Part B can be a premium increase of up to 10% for each 12-month period that you were eligible for Part B but not enrolled.10
So, for example, if three years lapsed between the time you became eligible for Part B and the time you decided to enroll, you would face a late enrollment penalty of 30% of the premium.
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Adult & Child Dental Insurance In The Marketplace
Under the health care law, dental insurance is treated differently for adults and children 18 and under.
- Dental coverage is an essential health benefit for children. This means if youre getting health coverage for someone 18 or younger, dental coverage must be available for your child either as part of a health plan or as a stand-alone plan. Note: While dental coverage for children must be available to you, you dont have to buy it.
- Dental coverage isn’t an essential health benefit for adults. Insurers dont have to offer adult dental coverage.
What The Dental Vision Hearing Package Covers
This additional coverage gives you:
- Dental exams, cleanings, x-rays and fluoride at no additional cost when you use an in-network provider
- In-network vision coverage that includes standard lenses every 12 months
- One hearing exam every 12 months and savings of up to 60% off average retail hearing aid prices at a TruHearing® provider
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Dental Plan Categories: High And Low
There are 2 categories of Marketplace dental plans: High and low.
- The high coverage level has higher premiums but lower copayments and deductibles. So you’ll pay more every month, but less when you use dental services.
- The low coverage level has lower premiums but higher copayments and deductibles. So youll pay less every month, but more when you use dental services.
When you compare dental plans in the Marketplace, youll find details about each plans costs, copayments, deductibles, and services covered.
