Medicare doesn't cover most dental care (including procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices), or eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses.
Let's discuss dental first; Original Medicare coverage of dental expenses is limited to situations where the dental treatment is integral to other medical treatment. Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you're in a hospital. Part A can pay for hospital stays if you need to have emergency or complicated dental procedures, even though it doesn't cover the dental care. You pay 100% for non-covered services. Original Medicare may pay for some dental services before, or as part of, certain related medical procedures (like before certain cardiac or organ transplant procedures).
You can purchase separate dental plans which commonly have benefit maximums of $1,000 or $2,000 per year, and some services have a waiting period before benefits can be utilized.
Now for vision care, you pay 100% for eye exams for eyeglasses or contact lenses when covered by Original Medicare. However, there are exceptions when you have diabetes, glaucoma, and/or macular degeneration.
Eye Exams (for diabetes)
Medicare Part B (Medical Insurance) covers eye exams for diabetic retinopathy once each year if you have diabetes. The exam must be done by an eye doctor who’s legally allowed to do the test in your state.
Glaucoma Tests
Medicare Part B covers glaucoma tests once every 12 months if you’re at high risk for developing the eye disease glaucoma. You’re considered at high risk if at least one of these conditions applies to you:
You have diabetes.
You have a family history of glaucoma.
You’re African American and age 50 or older.
You’re Hispanic and age 65 or older.
Macular Degeneration Tests & Treatment
Medicare Part B may cover certain diagnostic tests and treatment (including treatment with certain injected drugs) of eye diseases and conditions if you have age-related macular degeneration.
Your cost for covered vision services is typically 20% of the Medicare-Approved amount for your doctor's services after you meet the Part B deductible. In a hospital outpatient setting, you pay a copayment.
For dental or vision, you can find out how much your procedure or service will cost by talking to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
Other insurance you may have.
How much your doctor charges.
If your doctor accepts assignment.
The type of facility.
Where you get your test, item, or service.
WC Insurance Solutions can help you determine what coverage option might be best for you. Call, email, or use our website. https://www.wcinsurancesolutions.com/contact-us
Source: Medicare.gov
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