Original Medicare covers very few routine vision or dental services
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). Part A covers things like inpatient hospital care, skilled nursing facility care, lab tests, and surgery, while Part B covers outpatient care, doctor’s appointments, durable medical equipment, and preventive screenings and services.
Medicare offers hospital and medical benefits for a number of services beneficiaries may need, but it doesn’t cover everything. That’s why some beneficiaries choose to enroll in a Medicare Advantage plan (Part C) or other type of supplemental coverage.
Read on to learn more about Medicare benefits for vision and dental coverage, as well as additional options you may have.
Medicare coverage for vision and dental
Under most circumstances, vision services and dental are not covered by Original Medicare.
Does Medicare cover vision?
Medicare does not cover routine eye exams for eyeglasses or contact lenses. You would pay 100% out-of-pocket for an eye exam. Medicare also typically does not cover eyeglasses or contact lenses. However, Part B helps pay for corrective lenses if you have cataract surgery that implants an intraocular lens. After you meet the Part B deductible, you’d pay 20% of the Medicare-approved amount for prescription lenses.
Cataract surgery is also covered if done using traditional surgical techniques or using lasers.
Additionally, Medicare Part B will cover one eye exam per year for diabetic retinopathy if you have diabetes, as well as one glaucoma test every 12 months if you’re at high risk for developing glaucoma. In both of these cases, you’d be responsible for paying 20% of the Medicare-approved amount after meeting the Part B deductible. In a hospital outpatient setting, you may have an additional co-pay.
Does Medicare cover dental?
Medicare does not cover most dental care, including procedures like:
- Tooth extractions
- Dental plates
- Other dental devices
The exception is that Part A will pay for certain dental services that you get when you’re in a hospital. For example, it may cover a hospital stay if you need to have emergency or complicated dental procedures. Medicare will also pay for dental services that are an integral part either of a covered procedure (like reconstruction of the jaw after an injury) or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw.
You would pay 100% of the cost for non-covered dental services.
Do Medicare Advantage plans cover vision and dental?
Medicare Advantage plans are offered by private insurance companies. These plans are required to cover everything Original Medicare Part A and Part B does, but they also typically offer additional coverage for things like prescription drug coverage (Part D), vision, dental, and hearing.
While exact coverage and costs will vary by plan, most plans offer:
- Routine eye exams, basic eyeglasses, contact lenses, or prescription sunglasses, and fittings for frames or lenses
- Routine dental visits for exams, cleanings, and other basic services (including X-rays). Some plans may offer more comprehensive dental coverage including fillings, crowns and bridges, extractions, root canals, dentures, and dental implants
In most cases, preventive care is $0 if you use an in-network provider. More comprehensive coverage may have an additional co-pay.
Contact your plan to learn more about specific benefits and coverage, as well as costs.
To compare plans near you, use our Find a Plan tool. Just enter your zip code and any prescriptions you take, then close any popup windows you don’t want to answer to review Medicare plans in your area.
Do Medicare Supplement plans cover vision and dental?
Medicare Supplement plans, also known as Medigap, help pay your costs when you have Original Medicare. This includes expenses like deductibles, co-pays, and co-insurance. Because Original Medicare does not cover vision or dental benefits, Medicap plans do not either.
Vision coverage costs
If you need vision care coverage, a Medicare Advantage plan is only one option. You can also purchase a standalone vision plan. Premiums for vision coverage vary based on several factors, including where you live and the coverage you need, but you should ensure a plan offers eye care benefits like eye exams, eyeglass frames, contact lenses, and possibly LASIK (if that’s something you’re interested in).
Keep in mind that most vision insurance plans have a network of providers, and the services will only be covered if you stay in-network. There are also typically co-pays and coverage limits that should be taken into consideration.
Without vision insurance, the average cost of an eye exam is about $150, and glasses frames and lenses can be $200 or more depending on the style you choose and correction you need. In many cases, vision insurance costs around $10 to $15 per month with a co-pay of $10 or less for an annual eye exam.
Another option is a vision discount plan, though these require you to pay a monthly membership fee. Additionally, these plans don’t pay the provider directly and instead you must pay the cost out-of-pocket but at a discounted rate. While there are no ongoing co-pays, there is a one-time application fee to enroll. Plus, not all providers accept discount plans.
Related reading: Dental, Vision, and Hearing Insurance
Dental coverage costs
There are also several options for dental coverage, including Medicare Advantage and standalone dental plans. The average cost of a standalone dental insurance plan can start around $20 per month for basic preventive plans, up to $80 or $100 for more comprehensive coverage that would include things like basic and major dental work. These plans may also come with premiums, deductibles, and co-pays.
Another option to explore is talking with a local dental school. If there’s one available, they may offer discounted services to help their students train. Additionally, ask your dental office about in-house membership plans that may help patients without dental coverage purchase care in advance at a discounted cost.
Find a Medicare Plan in your area
It's FREE with no obligation