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Jul 17

Why Doesn’t Medicare Cover Glasses or Dental?

 Toni,

             Will be eligible for Medicare this year and trying to compare Medicare to my company benefits? I think that I understand the alphabet soup for Medicare, i.e.  Parts A, B and D. Why doesn’t Medicare cover eye glasses/vision benefits or dental work? What general insurance options do you recommend for these benefits?

            Regards, John from Spring,TX

Hi there…John:

            On page 54 of the 2013 Medicare & You handbook under “What’s NOT Covered by Part A & Part B?”  It states… “Medicare does not cover everything and if you need certain services that Medicare doesn’t cover, you will have to pay for them yourself unless you have other insurance to cover the costs.”

                        The Medicare & You handbook also states…

·       You may have other insurance (including Medicaid) that could cover the costs.

·       You may be in a Medicare health plan such as Medicare Advantage (Part C) that may cover these services.

·       Remember, that if Medicare covers a service, then you generally have to pay deductibles, coinsurances and co pays.   

Here are some items Medicare does not cover:  Long term care, routine dental care, dentures, cosmetic surgery, acupuncture, hearing aids and exams for fitting hearing aids. 

            Since Medicare doesn’t cover dental, I would recommend that you talk to your dentist and see which dental insurance plan he/she prefers. Talk with the office manager because they know which dental plan has the most benefits or should I say gives “you the most bang for your bucks”.  There are 2 different types of dental plans: 1) Traditional or indemnity dental insurance plans which is generally higher in premium and the preventive services are usually covered at 100%, basic restorative is generally covered up to 80% and major procedures at 50%. Many of the traditional/indemnity dental plans may have a wait for services such as fillings, root canals, bridges, crowns, etc. 2) Discount dental plans are generally less expensive than traditional dental plans.  These are plans that give a discount for services, but your doctor must be part of the plan and agree to give the dental discount.

            Make sure you understand which dental plan you pick because many can have a 6 month to a 2 year wait or longer for expensive dental procedures such as crowns, implants, etc.

            John, you also asked about vision benefits including glasses.  On page 39 of the Medicare handbook, it talks about Eyeglasses which is a limited benefit because Medicare will cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens.  The Medicare Part B deductible will apply and you will pay the 20% of the Medicare-approved amount. 

            Medicare defines glasses as an elective.  Do not understand why vision is considered elective(not covered), but it is. 

            Hearing aids are also considered elective, just like glasses. “Medicare covers the exams if your doctor or other health care provider orders them to see if you need medical treatment.  Again you pay the 20% of the Medicare-approved amount and the Part B deductible applies.”  Medicare does not cover the hearing aids or exams for fitting the hearing aids and this can be expensive. 

            You can see that you cannot compare Medicare to your company benefits.  And if you can keep these benefits when you retire, it might be a good idea. . 

            Do you live in West U/Houston area…join me on Tuesday July 16th at 6:00 PM for the  “Confused about Medicare” workshop at the West University Place Senior Center located at 6104 Auden, West University Place, (Houston) TX, 77005.  Workshop is free, RSVP at 832/800-4674.

            Toni King, Medicare advocate, consultant and author of Medicare Survival Guide available only at www.tonisays.com and not sold in bookstores. Sign up for the new Medicare Survival newsletter available at www.tonisays.com.

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