How you can get dental 
and vision insurance

  1. Some Medicare Advantage (Medicare Part C) plans include dental benefits. Medicare Advantage plans must cover as much or more benefits offered by Medicare Part A and Medicare Part B. But, unlike Original Medicare, Medicare Advantage plan benefits vary. Not all Medicare Advantage plans include dental coverage, so shop around. Medicare Advantage plans are sold through private insurers.


2.  You can also get private dental insurance either through an agent or an employer. Compare different types of dental plans to fit your dental needs. Dental plans can vary in terms of what's covered, how much you pay each month, and how much you pay out of pocket for dental exams and dental procedures.
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NEED TO ADD DENTAL AND VISION INSURANCE?  WE CAN HELP!

Finding out that dental insurance and vision insurance are not standard benefits within Original Medicare has been a big disappointment for many we work with.  This is particularly true for those accustomed to having dental and vision insurance as part of their workplace insurance.


As outlined in the Dental and Vision Insurance and Medicare below, some Medicare Advantage Plans offer additional benefits like dental and vision.  It is important to review your coverage options and evaluate any additional options available.  Stand-alone dental and vision insurance may always be added at any time.  Very limited dental and vision services are covered Medicare services.  Check our blog post on dental benefits and medicare and visit medicare.gov to learn more.

WE OFFER DENTAL AND VISION INSURANCE

Continuing to meet the needs of our clients, we offer stand-alone dental and vision insurance for individuals with Medicare.  This can be as a bundle of dental and vision together or independently.  If you need dental and vision together or dental or vision only, we will have a plan to meet your needs.  We have providers offering individual plans or family.  


With more than a dozen plans and offerings in West Virginia through Medico, United Concordia, Renaissance and Humana, we can find a coverage option to meet your needs.


If the Medicare coverage you have selected does not include dental and vision, you may add a plan from one of our providers at any time.  You are not tied down to enrollment periods and can add or drop coverage at any time.  Contact us or call (304) 201-0100 to discuss adding dental insurance, vision insurance or both.

MEDICARE DENTAL BENEFITS

Does Medicare ever cover dental services?  

Medicare will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings or pay for you to get fillings. Medicare will never pay for dentures. Even if Medicare has paid for you to have a teeth pulled (extracted) as preparation for a medical procedure, you will be responsible for the cost of your dentures.


Note: Some Medicare Advantage plans cover routine dental services. If you have a Medicare Advantage plan, check with your plan to see what dental services may be covered.


However, Medicare will cover some dental services if they are required to protect your general health, or you need dental care in order for another health service that Medicare covers to be successful.


Medicare will pay for dental services if, for example:

  • You receive an oral examination in the hospital because you will be having a kidney transplant or in a rural or federally qualified health clinic before a heart valve replacement; 
  • You have a disease that involves the jaw (like oral cancer) and need dental services that are necessary for radiation treatment;
  • You had a facial tumor removed and had ridge reconstruction (reconstruction of part of the jaw) as part of that procedure;
  • You need surgery to treat fractures of the jaw or face;
  • You need dental splints and wiring as a result of jaw surgery.


While Medicare may pay for these initial dental services, Medicare will not pay for any more follow-up dental care after the underlying health condition has been treated. For example, if Medicare paid for a tooth to be removed (extracted) as part of surgery to repair a facial injury you got in a car accident, it will not pay for any other dental care you may need later because you had the tooth removed.


Medicare will pay for some dental-related hospitalizations, for example, if you develop an infection after having a tooth pulled; you require observation during a dental procedure because you have a health-threatening condition.


Note: Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists.


While Medicare may pay for in-patient hospital care in these circumstances, Medicare will never cover any dental care specifically excluded from Original Medicare (i.e, dentures), even if you are in the hospital.

MEDICARE VISION BENEFITS

Generally, Original Medicare (Medicare Part A and Medicare Part B) does not cover routine vision care except in certain cases. Medicare Part A does not cover vision care unless something happens to the eyes that requires hospitalization. Medicare Part B does offer some vision benefits, but not everything related to vision care is covered. Other vision care benefits are covered by Medicare Advantage (Medicare Part C) plans, but you may have to pay higher premiums to get these vision benefits.


For vision care that is covered by Original Medicare, you will pay 20% of the amount approved by Medicare.


Routine Vision Care

Medicare Part A and Medicare Part B do not cover routine vision care as part of vision benefits. However, Medicare Part B vision benefits include one preventive vision screening per year for those at high risk for glaucoma. People at high risk for this degenerative vision disease are African-Americans over 50, people with diabetes and people with a family history of glaucoma.


Some Medicare Part C plans cover routine vision care as part of their vision benefits.


Eyeglasses, Intraocular Lenses and Contact Lenses

Some Medicare Part C vision benefits cover eyeglasses, intraocular lenses and contact lenses, but Original Medicare generally does not include these vision benefits except following cataract surgery.


Cataract Surgery

Medicare Part B vision benefits cover the cost for cataract surgery. This includes the cost to restore your vision by replacing the damaged lens with an artificial lens. Medicare will also cover the cost for one pair of eyeglasses, contact lenses or intraocular lenses that may be needed to correct your vision following cataract surgery. Medicare will only cover the cost for standard lenses. Medicare Part B vision benefits cover the cost to correct your vision with eyeglasses, contact lenses or intraocular lenses following cataract surgery even if the surgery happened before your Medicare coverage began.


Eye Prostheses

Medicare Part B covers the cost for eye prostheses for patients who have lost their vision in one or both eyes due to absence or shrinkage of the eye. Polishing and resurfacing of prostheses is covered by Medicare Part B vision benefits twice per year.


Medicare Part B vision benefits cover one enlargement or reduction in size. Medicare Part B vision benefits cover additional enlargements and reductions, but only with documented medical necessity.


Replacement of lost or stolen eye prostheses is covered by Medicare Part B vision benefits after five years of use. Medicare will cover the cost for replacement eye prostheses only if lost, stolen or irreparably damaged during the first five years of use.


Eye Refraction Tests

An eye refraction test is a simple procedure to check a person's vision. Medicare Advantage plans do offer coverage for these vision tests, but Original Medicare does not offer this vision benefit.


Treatment of Macular Degeneration

Macular degeneration is a disabling vision disease associated with aging that gradually causes a loss of vision in the center of the visual field. The condition can make it hard to read or recognize faces even though your vision allows you to see around the edges. Medicare Part B vision benefits cover the cost of photodynamic therapy with verteporfin, which is a treatment for macular degeneration.


Vision Medications

Medicare Part D (prescription drug coverage) covers the cost of some vision medications like eye drops, but the medications must be prescribed by a licensed physician.

Medicare has neither reviewed nor endorsed this information.

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