When it comes to vision and dental care, things can get a bit confusing concerning what coverage you have with your Medicare benefits. Because Original Medicare Part A and Part B provide coverage for care that is medically necessary, they do not help pay for routine vision and dental care such as regular examinations, teeth cleanings or fillings, tooth extraction, eyeglasses or contact lenses.
But not all vision and dental care is routine. Your Original Medicare insurance (Parts A and B), or Medicare Advantage Plan (Part C), may offer coverage for certain preventive and diagnostic exams, treatments, surgeries, or some supplies. It is important to know what coverage you have regarding your vision and dental care. Having all the information about your Medicare benefits is essential for making the best decisions regarding your health care.
How does Medicare cover vision care?
If you require vision care as a medical emergency or due to traumatic injury, Original Medicare Part A (Hospital Insurance) covers that care if you are treated as an inpatient in a hospital. You must be formally admitted as an inpatient at a Medicare-approved facility.
Medicare recipients who have Original Medicare Part B (Medical Insurance) have coverage for the following preventive and diagnostic eye exams:
- Eye examinations for diabetics to test for diabetic retinopathy one time per year.
- Glaucoma tests once every 12 months if you are considered at high risk for glaucoma. People at high risk are:
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- Diabetics
- People with a family history of glaucoma
- African Americans over 50 years old
- Hispanics over 65 years old
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- Macular degeneration tests and treatment. If you have age-related macular degeneration (AMD), your Part B insurance covers a diagnostic examination and treatments with certain injected drugs.
For all the above examinations and treatments, Medicare Part B recipients are responsible for 20 percent of the final Medicare-approved amount for physician’s services and the Part B deductible of $185.00 applies. For services in a hospital outpatient setting, you may have a copayment.
The final cost of the service depends on what your doctors charge and whether they accept Medicare assignment. It also depends on what other insurance coverage you have, the type of facility your visit, and your location.
For eyeglasses and contact lenses, Medicare Part B helps pay for them if you have had cataract surgery to implant an intraocular lens. This coverage includes one pair of glasses with standard frames, or one set of contact lenses from a supplier that is enrolled in Medicare. If you wish to have upgraded frames, you are responsible for the additional cost.
Cataract surgery is covered under Medicare Part B if it is done using traditional techniques or with laser surgery and it is deemed medically necessary.
Does Medicare Cover Dental Care?
In most cases, Original Medicare Part A and Part B do not offer coverage for routine dental care or procedures such as cleaning, fillings, extractions, dentures, plates, or other devices.
Medicare Part A pays for certain dental services that you may receive while you are in the hospital. Part A may help cover your inpatient care if you require an emergency dental procedure or a complicated dental procedure requiring hospitalization.
If you have Original Medicare, your personal cost for dental services that aren’t covered is 100 percent. Many Medicare recipients choose to get their Part A and Part B benefits through a Medicare Advantage plan (Part C). Medicare Advantage plans are offered by private insurance companies that contract with Medicare, and many provide additional benefits, including vision and dental care.
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