Tuesday, April 16, 2024

Medicare Vision And Dental Plans 2021

Most Plans Have A Provider Network

Medicare Dental Vision Hearing Plans in 2021

Dental provider networks come in two basic varieties: Dental HMOs and Dental PPOs. In a DHMO, you have to see a network dentist and because their networks are limited, you probably won’t get to see your current dentist. The trade-off is generally lower costs and a simpler fee structure. A DPPO also has a network of dentists, but insurance companies typically let you go outside the plan. And if your coverage is from a large insurance company like Guardian, with a broad provider network, you may find that your current dentist is in the PPO.

Dental Coverage With Medicare Advantage Plans

Medicare Advantage Plans , sometimes called Part C, combine Original Medicare Part A and Part B into one complete plan. These plans are offered through private insurance companies approved by the government Medicare program. These plans may also offer extra programs and services not covered by Original Medicare, such as dental coverage. Some plans may also include Part D prescription drug coverage and vision.

Medicare Advantage Plans work similarly to traditional health plans in cost and coverage. For example, there are HMOs, PPOs, POS plans, and more. They can include deductibles, copays, and coinsurance .

But not all Medicare Advantage Plans cover dental care. So before you sign up, make sure to read the details of what the plan covers. If you want Medicare dental coverage, then make sure the Medicare Advantage Plan you choose covers the dental care services that you need.

The Ads For Supplemental Medicare Advantage Plans Describe Vision And Dental Benefits Even Grocery Discounts And Food Deliveries But Look At The Fine Print

When Teresa Nolan Barensfeld turned 65 last year, she quickly decided on a private Medicare Advantage plan to cover her health expenses.

Barensfeld, a freelance editor from Chatham, New York, liked that it covered her medications, while her local hospitals and her primary care doctor were in the plans network. It also had a modest $31 monthly premium.

She said it was a bonus that the plan included dental, hearing and vision benefits, which traditional Medicare does not.

But Barensfeld, who works as a copy editor, missed some of the important fine print about her plan. It covers a maximum of $500 annually for care from out-of-network dentists, including her longtime provider. That means getting one crown or tending to a couple of cavities could leave her footing most of the bill. She was circumspect about the cap on dental coverage, saying, I dont expect that much for a $31 plan.

Through television, social media, newspapers and mailings, tens of millions of Medicare beneficiaries are being inundated this month as they are each autumn during the open enrollment period by marketing from Medicare Advantage plans touting low costs and benefits not found with traditional Medicare. Dental, vision and hearing coverage are among the most advertised benefits.

There is almost always a trade-off such as narrower provider networks, tighter drug formulary or restrictions in other areas, she said.

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Medicaid And Medicare Enrollees Need Dental Vision And Hearing Benefits

More than 88 million adults in the United States are enrolled in Medicare or Medicaid. Most do not have comprehensive health coverage for vision, dental, or hearing benefits, often leaving them without the care they need to protect their health and quality of life. Congress increasingly appears to be considering adding coverage for these services in Medicare as it should. But in doing so, it should also guarantee access to the same benefits for low-income adults with Medicaid coverage.

Lack of access to dental, vision, and hearing care can pose serious risks for overall health. The absence of routine care can delay diagnosis of some serious health conditions, leading to complications and more costly treatments later. For example, researchers have found that lack of dental coverage in Medicaid leads to additional emergency department visits dental-related emergency department visits increased by 32 percent among adult Medicaid enrollees in California after the state eliminated dental coverage in 2009. Even when not associated with other health concerns, dental, hearing, and vision problems can decrease individuals quality of life and impede participation in their communities.

“Ensuring that Medicaid as well as Medicare enrollees can access these benefits could reduce disparities in access to care and prevent more serious health problems.”

Does Medical Insurance Cover Vision And Dental

Did you know Medicare Advantage is also known as Part C and provides ...

Health insurance coverage typically does not provide benefits for routine dental and eye care services, nor do they offer discounts for things like eyeglasses. However, medically necessary, non-cosmetic procedures to treat issues like eye disease will typically be covered in a health care plan. Also, Affordable Care Act compliant health insurance plans purchased on an exchange must include dental and eye care benefits for children, but that is not required for adults.

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Original Medicare Dental Coverage

Original Medicare covers limited dental care. It does not cover most dental care or supplies, such as:

However, Medicare Part A will typically provide some coverage if you receive any dental services in a hospital as an inpatient.

  • For example, Part A may cover the cost of a tooth extraction that is necessary to prepare your jaw for radiation treatment.
  • Or if you are admitted to the hospital with severe injuries to your mouth and emergency care is required, Part A might again provide limited coverage.

“Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isnt covered,” according to Medicare.gov.

If you need dental coverage for routine dental care services and supplies, you may want to enroll in a Medicare Advantage plan that includes that benefit.

Best For Special Needs: Cigna


If you have special dental needs as a senior on Medicare, then Cigna is a good choice. They offer special needs plans and an increased range of services for customers who need them.

  • Some plans don’t include prescription coverage

We chose Cigna as the best for special needs because of their personalized plan offerings. While other Medicare Advantage Plans limit coverage to individuals with special health conditions or care needs, Cigna offers special needs plans that include access to a wider range of specialists, along with regular health assessment .

Depending on your health care needs, Cigna offers an increased range of services, whether that is more intensive treatments, personalized care treatments, or more individual specialist attention.

Based on a review of Cignas Model of Care, the National Committee for Quality Assurance has approved Cigna to offer Special Needs Plans until 2021 . Annual NCQA approval is required for this plan type.

Cigna offers a health risk assessment that can be used to develop personalized care plans with Cigna Medicare Advantage Plan enrollees and their primary care doctor. The HRA also helps match each enrollee with the health and wellness services that best fit their needs.

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Best For Size Of Dental Network: Unitedhealthcare

Average Medicare star rating: 4.2 out of 5.

Service area: Available in 50 states and Washington, D.C.

Standout feature: UnitedHealthcare has the largest network of dental providers of all Medicare Advantage companies, with approximately 100,000 providers.

UnitedHealthcare is the biggest provider of Medicare Advantage plans in the U.S., with a presence in all 50 states and plans available in almost three-quarters of U.S. counties. UnitedHealthcare also partners with AARP and insures Medicare products with the AARP name. Many of UHCs members are in plans with high star ratings.


  • UHC offers the largest Medicare dental network, with approximately 100,000 providers.

  • UHC plans with comprehensive dental coverage include an average of six services per plan.

  • Three-quarters of UHC Medicare Advantage members are in highly rated plans.


  • Only 75% of UHC plans offer comprehensive dental coverage, one of the lowest among the major Medicare Advantage providers.

  • UHC tied for sixth out of nine providers on J.D. Powers latest Medicare Advantage study, which measured member satisfaction.

Best National Coverage: Aetna

2021 How to use Medicare Plan Finder, step-by-step
  • Coverage Limit : $1,000 to $4,500
  • Providers In Network: 700,000

With plans offered in all 50 states, Aetna is our top choice for national coverage. The insurer features a provider network of over 1.2 million health care professionals across the country.

  • Available in all 50 states

  • Large provider network

  • Not all plans offered in all areas

  • Not all plans come with dental coverage

We chose Aetna as best for national coverage for its operations in all 50 states. Aetna has approximately 12.7 million dental members, and their network includes about 1.2 million health care professionals, with over 700,000 primary care doctors and specialists.

With many of their Medicare Advantage plans, Aetna offers home delivery of most prescription drugs through their mail-order pharmacy: CVS Caremark. Aetna also offers a concierge program with many of its Medicare Advantage plans. An Aetna concierge can help you manage your health care expenses, understand your benefits, locate providers near you, and help plan for treatments.

Founded in 1853, Aetna has a full range of plans with premiums ranging from $0 to nearly $100 each month, depending on your needs and location.

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Medicare Advantage Dental Benefits

Medicare Advantage plans may provide extra benefits that are not covered under traditional Medicare, such as dental, vision, hearing, and fitness benefits. The cost of these benefits may be covered using rebate dollars. Plans can also charge additional premiums for such benefits. In 2021, 94% of Medicare Advantage enrollees in individual plans, have access to some dental coverage. The majority of these Medicare Advantage enrollees have access to a plan with more extensive coverage, while 14% had access to preventive coverage only. Preventive dental coverage under Medicare Advantage plans generally includes oral exams, cleanings, dental x-rays, and sometimes fluoride treatments. More extensive benefits cover a range of services, including restorative services , endodontics , periodontics , prosthodontics , and oral surgery.

The Scope of Covered Dental Benefits Varies Across Medicare Advantage Plans

Virtually all Medicare Advantage enrollees in plans that offer access to dental benefits , have access to preventive services, including oral exams , cleanings , and x-rays , although fewer enrollees have access to fluoride treatment .

like other dental benefits, coverage for dentures varies across plans

Medicare Advantage Plans That Offer Dental Benefits Typically Have an Annual Dollar Cap on Dental Coverage

Preventive Services Are Often Covered Without Cost Sharing For More Extensive Dental Services, 50% Coinsurance and Caps Are the Norm

How Does Medicare Advantage Dental Coverage Work

Medicare Advantage plans are the primary method for dental coverage under Medicare.

Whatâs usually covered:

  • Tooth extractions

Medicare Advantage are bundled plans that combine add-on benefits such as dental or vision with Original Medicare and additional cost-sharing for medical needs. About 94% of Medicare Advantage plans offer the option for dental coverage. However, sometimes there is an additional fee to include dental coverage in your plan.

For example, the standard Medicare Advantage plan from Kaiser Permanente does’t include dental care, but if you upgrade to the Medicare Advantage Plus plan, you’ll get dental, vision and hearing coverage.

The level of dental coverage with Medicare Advantage plans varies. Some have an annual payout limit, such as only contributing $1,500 to your dental care each year. Other plans could have coverage specifications on the number of cleanings per year or denture coverage.

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Does Medicare Cover Vision And Dental Care

Original Medicare does not cover routine dental or vision care. Under some conditions, Original Medicare may cover some dental or optical care in an emergency or as part of the preparation for surgery.

When it comes to dental and vision coverage, you may be able to enroll in a Medicare Advantage plan with dental and vision benefits.

What Does Medicare Cover For Dental Care


Some Medicare Advantage plans may offer additional benefits for dental care, including services related to dental implants. Medicare Advantage plans are offered by private Medicare-approved insurance companies, so they are able to include supplemental benefits not available under Original Medicare. For example, many Medicare Advantage plans include coverage for routine dental care such as annual exams and cleanings.

Some Medicare Advantage plans even offer supplement dental insurance with coverage for more complex dental procedures such as extractions, fillings, and other types of tooth replacement or restoration, which may include dental implants. You may have to get your dental care from a network provider, and your plan may only pay a set amount for these additional services, regardless of the actual charge. There may be a separate monthly premium for supplemental dental insurance with your Medicare Advantage plan.

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Best Medicare Dental Coverage For Seniors

The best dental insurance for most seniors is a Medicare Advantage plan from AARP/UnitedHealthcare because of its large network of dentists. We also recommend Aetna for low-cost dental coverage. If you need dental care right away, a stand-alone plan from Humana can provide comprehensive benefits starting the first day of coverage.

Which Is Better Dental Insurance Or A Dental Discount Plan

A dental discount plan doesn’t provide coverage for dental costs it just makes certain discounts available if you use one of their dentists. By comparison, a quality Dental PPO plan will typically provide the same or better discounts when using in-network providers, but you may also get checkups and cleanings covered at 100%. A full-coverage DPPO will also help cover portions of major procedures such as crowns and bridges and may even cover orthodontic care.

2 “Systemic manifestations of oral diseases,” www.ncbi.nlm.nih.gov/pmc/articles/PMC3329699/

3 “Stay in Good Company” Guardian Dental Health eBook

4 Common Glasses Statistics, , Last accessed Nov, 2021

Brought to you by The Guardian Life Insurance Company of America , New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment, or medical advice. Although the information has been gathered from sources believed reliable, please note that individual situations can vary, therefore the information should be relied upon when coordinated with individual professional advice.

Vision Insurance is provided by VSP and billing and premium collection services for such vision insurance are conducted by DTC GLIC, LLC . DTC GLIC, LLC is a wholly owned subsidiary of The Guardian Life Insurance Company of America .

2021-121902 20231031

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Medicare Advantage Supplemental Dental Vision And Hearing Enrollment Forms

Who is this for?

If you have one of our Medicare Advantage plans and want more dental, vision and hearing coverage, find the enrollment form here.

Want more dental, vision and hearing coverage to go with your Medicare Advantage plan? We offer optional supplemental buy-up packages you can add for a low monthly price.

How To Shop For Medicare Advantage Plans

Best Dental+Vision+Hearing Plan to use with Medicare

Medicare Advantage plans arent just about dental coverage youve got to get the right coverage for all of your health care. Here are some strategies for finding the best plan for you:

You can sign up for a Medicare Advantage plan when you first become eligible for Medicare or during designated annual enrollment periods, such as Medicare open enrollment in the fall and Medicare Advantage open enrollment in the spring.

For information on the Medicare Advantage plans near you, use Medicares plan finding tool to see whats available.

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Medicare Vision And Dental Insurance

  • Andrea Feucht, 01/13/2021 12:00 am

If youre covered by Medicare , you probably know most Medicare plans only cover vision and dental emergencies, like being admitted to a hospital with injuries to your face. Annual eye exams, eyeglasses, dental exams, fillings and more are not covered by Original Medicare.

Knowing this, you might already have vision and dental insurance through Medicare Part C . But is your current coverage the right fit for your needs? Its possible that individual dental and vision insurance through a company like VSP is a better match for you. To help you make sure you have the best vision insurance and dental coverage, well take you through some key considerations.

The Best Vision Insurance for Medicare Has a Large Network

Vision health is so important, especially as we enter retirement age because over time, changes in your vision can show up that affect daily life. The best vision insurance for retirees will make it easy to get annual eye exams with a large network of eye doctors. VSP, for example, has the nations largest network of optometrists more than 34,000 providers nationwide making it very likely that your eye doctor is already in our network or a new provider is conveniently nearby.

Not only do annual eye exams keep your vision correction up-to-date, but also includes screenings for eye problems like cataracts, macular degeneration and glaucoma. Eye exams can also detect signs of high blood pressure and the early signs of diabetes.

Can Medicare Advantage Or Medigap Cover Dental And Vision

Medicare Advantage plans, sold by private companies, often include some dental and vision coverage. However, not all plans have these added benefits. Their premiums, benefits, and deductibles vary, as with all health plans, and many people refer to them as all-in-one plans.

Medigap is supplemental insurance created to cover gaps in Original Medicare, such as deductibles and copays. Medigap will cover some coinsurance or deductible costs for emergency oral surgery or treatment of serious eye diseases, but Original Medicare also covers part of those expenses. Medigap does not cover routine eye or dental care.

Tip: You cant use Medigap and Medicare Advantage together. In fact, its illegal for someone to sell you a Medicare Advantage plan if you have Medigap.

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Congress Should Ensure That All Medicare And Medicaid Enrollees Have Access To Dental Vision And Hearing Benefits

If Congress considers legislation to expand coverage for dental, vision, and hearing benefits in Medicare as it should it should also require states to offer these critical services to low-income non-elderly adults with Medicaid coverage. Failing to do so would leave out a group even more likely to have unmet needs for dental care due to cost than Medicare enrollees.

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