Coverage for Dental, Vision, and Hearing: What Are Your Options?

Many beneficiaries are surprised to learn that Original health insurance (Parts A and B) does not cover routine dental, vision, or hearing services. These are essential aspects of health, especially for older adults, yet they often fall outside the scope of traditional health insurance coverage. However, there are several options to help pay for these services, ranging from private insurance plans to specialized Advantage plans. Here’s what you need to know about your coverage options and how to get the care you need.

Original Health Insurance and What It Doesn’t Cover

Original health insurance is great for covering hospital stays, doctor visits, and certain medical procedures, but when it comes to dental, vision, and hearing, it falls short. Parts A and B generally do not cover routine dental cleanings, exams, fillings, eyeglasses, contact lenses, or hearing aids. This can be a significant gap in care, as many seniors require these services to maintain their quality of life.

For example:

• Vision: While health insurance may cover eye exams related to specific conditions like glaucoma, cataracts, or macular degeneration, it doesn’t pay for routine exams, glasses, or contact lenses.

• Dental: Health insurance may only cover dental procedures that are integral to other medical care, such as tooth extraction before heart surgery.

• Hearing: Hearing aids, hearing exams, and routine hearing care are not covered, though certain diagnostic tests may be.

Advantage Plans (Part C)

If you need coverage for dental, vision, and hearing services, one of the most popular options is enrolling in an Advantage plan (Part C). These plans are offered by private insurers and often bundle coverage for hospital and outpatient care with additional benefits like dental cleanings, eye exams, and hearing aids.

A large percentage of Advantage plans offer some level of dental, vision, and hearing care. For instance, 88% of enrollees in Advantage plans had access to dental benefits in 2023, and 97% of plans offered routine vision coverage. These benefits can range from basic care (such as annual exams) to more comprehensive coverage, which may include fillings, crowns, prescription glasses, and hearing aids.

While Advantage plans provide extra benefits, there are some limitations to keep in mind:

• Network restrictions: You may be limited to a specific network of providers.

• Caps on coverage: Some plans limit the amount they will pay for dental, vision, or hearing services each year, meaning you may still face significant out-of-pocket costs.

• Premiums: Advantage plans may have additional premiums beyond what you pay for health insurance.

Standalone Dental, Vision, and Hearing Plans

If you prefer to stick with Original health insurance but still want coverage for these services, you can purchase standalone dental, vision, and hearing insurance from private insurers. These plans can offer a range of services, from basic preventive care to more extensive procedures, and often provide a larger pool of providers than Advantage plans.

Some plans even bundle all three services into one package. However, like Advantage, these standalone plans come with premiums, and you should carefully consider:

• What’s covered: Be sure to check what services are included and whether there are annual coverage limits or waiting periods.

• Costs: Monthly premiums can range from $20 to $50 for dental or vision-only plans and $30 to $75 for bundled plans covering dental, vision, and hearing.

Assistance Programs

For low-income beneficiaries, Medicaid can help cover some of the costs of dental, vision, and hearing care. Medicaid coverage varies by state, but many state programs include basic dental and vision services, though hearing care is less commonly covered. If you qualify for Medicaid, it’s worth checking your state’s specific coverage rules to see what’s included.

Other assistance programs that may help include:

• The Veterans Affairs (VA): If you’re a veteran, VA healthcare may cover vision and hearing exams, eyeglasses, and hearing aids.

• Nonprofits and Discount Programs: Organizations like Lions Clubs International offer assistance for vision care, and hearing aid manufacturers often have discount programs for seniors.

Dental, Vision, and Hearing Savings Plans

If you can’t find an affordable insurance option, savings plans can help reduce out-of-pocket costs. These plans are not insurance but allow members to receive discounts on services from a network of participating providers. They often charge an annual membership fee, which can range from $100 to $200 per year, and typically offer discounts of 10% to 60% on dental, vision, and hearing services.

Budgeting for Out-of-Pocket Costs

If you can’t get coverage for dental, vision, and hearing services, it’s crucial to budget for these potential out-of-pocket expenses. Here are some average costs to consider:

• Dental cleanings: $75 to $200 per visit

• Eyeglasses: $200 to $500 per pair

• Hearing aids: $1,000 to $4,000 per device

Given these costs, planning ahead and setting aside savings for future dental, vision, and hearing care is a smart financial move.