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Does Medigap cover dental and vision care?

Christian Worstell by Christian Worstell    |    Published Oct 03, 2019    |    Reviewed by John Krahnert

Medicare Supplement Insurance does not include dental and vision coverage. According to Medicare.gov, “Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.”

Medigap policies help cover some of the out-of-pocket costs not paid by Original Medicare. The 10 standardized Medigap plans provide up to nine different benefits, but do not include dental and vision coverage. The rules below do not pertain to the other Medigap plan categories such as waiver plans, non-standardized plans, and other plans not available for purchase. Although Medigap does not include dental and vision coverage, Original Medicare may provide dental and vision coverage in rare instances.

Vision and Dental Exceptions

There are a few circumstances when Original Medicare might cover dental and vision services.

Dental

Medicare does not cover most dental care, dental procedures, any supplies such as cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. However, Medicare Part A will pay for certain dental services performed in a hospital.

According to the Medicare.gov dental coverage rules, “Medicare Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isn’t covered.”

Vision

Original Medicare might offer some vision coverage, but it is also restricted. Original Medicare does not cover routine eye exams for glasses or contact lenses. However, Medicare Part B does cover some preventative and diagnostic eye exams for the following:1

  1. Yearly eye exam: a yearly eye exam to test for diabetic retinopathy
  2. Glaucoma tests: a yearly exam to test for glaucoma
  3. Macular degeneration: certain diagnostic tests and treatments for macular degeneration

For the three eye exams and tests listed above, Medicare Part B will pay for 80% of the Medicare-approved amount and you will be response for the remaining 20%.

Keep in mind that the Medicare Part B deductibles and co-payments still apply.

Deductibles and Copayments

If you have a Medigap insurance policy that includes Medicare Part B deductible and copayment coverage, the policy will cover the applicable out-of-pocket costs. Despite the exceptions stated above, Medicare and Medigap do not provide a standard level of dental and vision coverage.

Additional Options

If you need routine vision or dental care, you can apply for a private vision insurance or dental insurance plan. It is also worth noting that some Medicare Advantage (Medicare Part C) plans include dental and vision coverage.


1 https://www.medicare.gov/coverage/eye-exams.html

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