DENTAL, VISION & HEARING

Many people grow used to having their Dental, Vision, and Hearing (DVH)  needs met by a group insurance plan. What about those who aren’t offered benefits, exited the workforce, or are self-employed? Individual and family dental plans are available to most, regardless of age. Access to these plans are critical, especially to seniors whose overall comfort can rely on DVH health.

Combination plans that provide dental, vision, and hearing services are increasingly popular in the senior market. The majority of Medicare Advantage products offer some level of DVH care, but those on Original Medicare or a Medicare Supplement do not have comprehensive coverage in these areas. United Agent Resources offers multiple products to meet these needs.

What is Dental Insurance? 

Dental health plans may be available as a PPO, HMO, or another network type. Monthly premiums, deductibles, co-pays, and co-insurance determine the overall out-of-pocket expense. Dental procedures are typically grouped into three categories of coverage: preventive, basic, and major.  Most dental plans cover 100% of preventive care such as office visits for cleaning, X-rays sealants. Basic procedures include treatment for gum disease, extractions, fillings, and root canals. Most policies cover 70% to 80% of these procedures. Major services such as bridges, inlays, and dentures are typically covered at a high co-payment, with the patient paying more out-of-pocket. Cosmetic care, such as whitening, is typically excluded. It’s important to be informed about how a plan classifies services and be aware of any annual coverage maximums Excess costs must be paid in full by the patient.  

What is Vision Insurance? 

Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan. A vision benefits package acts like traditional health insurance. Plan premiums, copays, deductibles, and networks to provide coverage are all outlined in a Summary of Benefits. A discount vision plan provides eye care and eyewear at discounted rates after you pay an annual premium or membership fee, but may not provide coverage guarantees. 

Vision health costs typically include annual eye examinations, eyeglasses frames, lenses or contact lenses as necessary, and sometimes include surgeries for macular degeneration or LASIK vision improvement.

What is Hearing Insurance?

Plans that only provide for hearing health and treatment costs are very rare. It is much more common to find Vision or Dental & Vision plans that “come with” hearing care benefits. Hearing related healthcare includes listening tests and treatment for hearing problems. Some balance issues, like vertigo,  are related to the ear, and traditional health insurance may pick up the costs of hearing-related exams if that is the concern. The greatest costs in hearing care are typically not covered and are related to hearing aid exams, devices, and fittings.

What  Dental, Vision, and Hearing costs does Medicare cover?

Medicare (Parts A and B) doesn’t cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance)  will pay for certain dental services that occur in an in-patient hospital setting, such as emergency or complicated dental procedures, even though dental care isn’t covered.

There is no coverage through Original Medicare for any type of dental work unless it’s deemed medically necessary. This means Medigap policies cannot legally offer dental coverage. Medicare Advantage plans, because they are a privatized Medicare plan option, are allowed to offer dental health services. Many MA plans offer preventative and comprehensive dental coverage for a low cost, without waiting periods or with reduced waiting periods. This can be a great opportunity, especially for Medicare-Medicaid recipients that choose an MA plan. Out of pocket costs are typically eliminated for the Dual Eligible, even for denture needs! Coverage is typically tied to an HMO or PPO network.

Original Medicare does not provide coverage for the majority of eye care needs, but there are some distinct exceptions. Medicare Part B can cover preventive and diagnostic eye exams when Diabetes, Glaucoma, or Macular Degeneration are involved. Medicare covers eyewear only after cataract surgery.  Medigap plans are only able to cover the costs allowable under Original Medicare.  Medicare Advantage plans are able to offer vision coverage. Most will have a provider network in place and offer a pair of lenses and frames each year, no-cost preventative exams. Dual Eligibles will usually pay nothing out of pocket. 

Medicare Part B only covers diagnostic hearing and balance exams if related to medical treatment for vertigo or similar conditions. Original Medicare does not offer any coverage for hearing exams, hearing aids, or fitting hearing aids. Medigap plans are therefore unable to provide coverage outside these defined services. Medicare Advantage plans are able to offer hearing health and device coverage. Exams, hearing aids, and related costs are covered, typically for a low copay. Dual Eligibles will often have no out of pocket costs for hearing care.

 

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