Dental, Vision, and Hearing: Ancillary Plans for Medicare

 Vision care plays an important role in the life of those 65 and older. Nearly 80 percent of adult Americans use some sort of corrective lenses or eyewear, a number that has historically risen above 90 percent for the Medicare population. But eyeglasses, contacts, and corrective surgery aren’t the only things faced by the over-65 crowd. 

As we age, vision isn’t just affected by the physical shape of your eyes. Common refractive errors develop in our eyes over time, things like farsightedness, nearsightedness, or astigmatism. These are the common eye shape malformations that we typically address with corrective methods such as contacts, glasses, or LASIK surgery.

Cataracts, a clouding of the lenses of your eyes, are another eye disease you may encounter as you age thanks to genetic factors or ocular trauma. Cataracts are progressive, and make it harder to see over time if left untreated. The only treatment for cataracts is surgery.

Glaucoma, macular degeneration, and diabetic retinopathy are all progressively degenerative and frequently hereditary. All three may be controlled with prescription medication but also may require surgical intervention.

Original Medicare vision coverage is more robust than other ancillary coverages. While the most common uses of vision care, such as exams for prescription eyewear and the cost of contacts or frames, aren’t covered, many surgeries are.

If you have diabetes, Medicare will cover a special eye exam to monitor for diabetic retinopathy once a year. Original Medicare also covers an annual screening if you have any factors that put you at higher risk of developing glaucoma or if you have macular degeneration.

While LASIK eye surgery that is elective, or not medically necessary, isn’t covered by Medicare, medically necessary surgeries to treat cataracts or glaucoma are covered by Original Medicare. Remember, that coverage may still come with the Part B deductible, co-pays, and a 20 percent coinsurance, depending on whether you have a Medicare Supplement plan to complement your Medicare coverage.

Many treatments for common eye diseases don’t involve surgery but rather are controlled with long-term medication. In these instances, you’ll want to ensure your Medicare Part D plan for prescriptions covers whatever vision prescriptions you need.

Dental, vision, and hearing plans may not be wrapped into Original Medicare, but that certainly doesn’t mean forgoing the kind of preventative care that stops problems before they start. Instead, arm yourself with the knowledge to help make a decision that’s right for you. 

Medicare Advantage plans, also called Part C, are private alternatives to Parts A and B, and typically have Part D prescription coverage and some ancillary dental, vision, and hearing benefits wrapped in. Many people gravitate toward Advantage plans precisely because of these ancillary benefits.

Yet, the extent of Medicare Part C coverage for dental, vision, and hearing plans can vary a lot from plan to plan, so it’s important to consider the limitations of any plan you’re considering. For instance, a Medicare Advantage plan may limit hearing aid coverage to a single kind of hearing aid, which may not be useful if it’s not a type that fits you and your needs. Advantage plans also operate based on coverage networks like standard private care plans. So you’ll want to confirm whether a particular plan covers your preferred optometrist or dentist as part of its network.

Regardless of whether you go the route of Original Medicare or Medicare Advantage, for those who need vision, hearing, or dental health care, out-of-pocket spending will be far less for vision than for dental and hearing care.

Another strategy Medicare recipients use to cover dental, vision, and hearing care is self-pay. This means forgoing insurance for the basics of these coverages and instead paying for preventative care out of your pocket.

This is a particularly popular way to handle vision care, since most of the more extreme vision problems you might encounter are considered medically necessary and are covered under Medicare. Hearing care is also often paid for out of pocket, as the major cost for audiology visits is typically for the hearing aids themselves. 

If you’re interested in paying for dental, vision, or hearing care entirely out-of-pocket, it pays to acquaint yourself with your potential costs upfront.  For instance, research published by Kaiser Family Foundation (KFF) in 2021 noted the average out-of-pocket spending on dental services alone for Medicare beneficiaries of all kinds was $454 in the year they studied. Half of beneficiaries who used dental services paid about $874, and one in ten spent more than $2,000 out-of-pocket.

Those with Original Medicare often cover their vision, hearing, and particularly dental needs with ancillary plans. Ancillary plans provide coverage that is frequently outside the scope of regular health care — not just Medicare, but employer-provided health care or individual plans, as well.

Ancillary plans for vision, dental, and hearing are open to any consumer looking for these specific kinds of coverage. You may be able to find one that bundles coverage, but it’s important to price them both together and independently to get the best pricing and coverage comparison. 

Ancillary plans also often have pre-existing conditions exclusions, where you have to be on the plan for a certain amount of time before qualifying for coverage, such as waiting for six months before qualifying for a dental crown.