Dental and Vision
As you approach age 65, guess what else is going to be having a 65th birthday party too? If you answered, “Your inner self,” you’re correct, and somewhat spiritual. But another answer is your teeth.
Here is an interesting research tidbit. Clemson University did a study to see how many bites the average person makes each day. As part of their study they also calculated that the average bite contained17 calories of food. Doing the math, in order to limit ourselves to the optimum 2,000 calories a day, we should limit ourselves to 120 bites a day. Would you believe there are even forks available for dieters to calculate their daily bites? Bitedometers are like a pedometer for your mouth.
Doing a little math at 120 bites a day, that’s 44,000 bites in a year and 2,860,000 bites in our first 65 years. Almost three million bites later, it would be a wonder if our teeth weren’t feeling their age.
As for our vision, according to Vision Monday (an optical trade publication) about 87% of people over 65 wear eyeglasses. So unless you are in the lucky 13% who can still spot a hummingbird from 50 feet away without the need for glasses then chances are you are more like the rest of us who can’t spot an eagle from 10 feet away without our specs.
Before we discuss vision coverage there is a very important distinction to make which I am often asked about. Nearsightedness, farsightedness, astigmatism, even if your eyesight makes you Mr. Magoo if you remember that cartoon is not covered by Medicare. On the other hand, eye conditions that are medical in nature, such as cataracts or glaucoma, are covered by Medicare no differently than any other medical condition is.
Medicare covers most of what we would see an ophthalmologist to treat. It does not, however, cover optometrist appointments. Here is the distinction: An optometrist is not a medical doctor and cannot do eye surgeries. An ophthalmologist is a medical doctor who specializes in eye conditions and diseases.
Most eye surgery is covered by Medicare, except for vision correction surgery. It is similar to what Medicare covers for dermatology. A cancer spot on your skin is Medicare’s problem and is covered. An eye lift is your problem or desire and is not covered.
There are a few ways you might be able to get dental and vision coverage once you reach the Medicare stage.
1. Group Health Insurance: Some people can keep the dental portion of their current group health insurance while dropping the medical portion. If your Group Health plan enables you to do so then this is an option worth considering.
2. Medicare Advantage: If you sign up for a Medicare Advantage plan, some dental and vision coverage will likely be included.
3. Original Medicare: If you choose Original Medicare and want dental and vision coverage it is offered by several private dental insurance plans.
Medicare Advantage Plans: Dental, Hearing and Vision Benefits
Medicare Advantage plans want your business. These plans know that a great way to attract your business is by offering dental and vision benefits.
Most Medicare Advantage plans will include preventative dental coverage without any copay. This coverage typically includes two or three dental exams a year (why anyone would want to see the dentist three times in a year I am not sure), two cleanings and a set of x-rays. You’ll likely need to see a dentist who is in the plan’s network. Because of this you’ll need to determine if your dentist is in-network much as you would check for your doctors. I can help you with this search.
Some plans take dental benefits a step further by offering you an amount you can use for any type of dental which includes Comprehensive Dental. Root canals, for example, can be painful for two reasons: Both your tooth saying, “Ouch” and your wallet, “Ouching,” too. Some of that wallet, “Ouch.” can be soothed by a contribution of $500 to $2,000 yearly from your dental plan.
For those people who are less likely to need comprehensive dental it is still nice to have a plan that pays for their preventative dental in full as most Medicare Advantage plans do.
Most Medicare Advantage plans offer a free optometrist exam every year. They also contribute, typically between $150 and $250 towards eye glasses or contact lenses. It’s true that $150 to $250 may not get you the latest Gucci frames but at least it’s something.
Dental and Vision with Original Medicare
Neither Original Medicare, nor a Medigap supplement include any dental, vision or hearing coverage other than for Medicare covered dental which is limited to dental treatments that are part of a medical condition such as diabetes or breaking your jaw.
So whether you: Need your VISION to see your food to be able to cut it; Need to keep up your DENTAL to chew your food; Or your HEARING to hear yourself chewing
None of the above is Medicare’s concern.
Your option becomes to enroll in a private dental plan through carriers such as Delta Dental or Ameritas. Although I sell both carriers, and can help you sign up for a plan with either one, I generally recommend Ameritas. Delta’s advantage is that their network is a little larger than Ameritas. Even so, the reason I prefer Ameritas is because of their lower cost. Delta Dental charges around 50% more to people over 55 on the theory that older teeth have more dental cost, which probably makes sense. Ameritas treats all ages the same, which makes their plans considerable less costly for us 65ers.
My favorite Ameritas plan, PrimeStar Protect Network 2000, gives you $2,000 in dental benefits for between $35 and $45 a month depending on your location. You also get network savings which they’ve negotiated with their dentist network. This leads to 15% to 40% savings right out of the gate.
The plan gives you 100% of your Preventative Dental costs on day one. You get 50% reimbursement of Basic Dental (extractions and fillings) on day one that bumps to 80% once you’ve been on the plan for a year. You get 20% of Comprehensive Dental on day one (the expensive stuff such as root canals, bridges, and crowns). The amount bumps to 50% once you’ve been on the plan for a year.
Important Note: Plans do not cover pre-existing conditions that have been diagnosed at the time you join the plan.
You can check out the PrimeStar Protect Network 2000 and other Ameritas plans through my link below. You can also search if your current dentist is in-network on the site as well. The link is:
Ameritas also offers a basic vision plan for around $10 a month that gives you an eye exam, $130 towards glasses and network savings of 40% on the balance over $130.
You can also view what Delta Dental has to offer at my link:
Medicare Advantage Plans and Hearing Benefits
Often times, when I would meet a husband and wife together to discuss Medicare as part of the process I would ask the husband if he had hearing issues. The husband would most usually shake his head, “No.” His wife would then immediately pipe in, “Yes you do.”
Some wives may have been referring to his “selective hearing” but often the, “Yes you do,” was because at 65 many of us our losing part of their hearing range. For instance, we can’t hear higher-pitched voices as well as we once did. This is particularly common with men who tend to lose both hearing and hair younger than women do. One wonders if hair and hearing are related.
Many Medicare Advantage plans have hearing benefits. These benefits usually work through a vendor or vendors that are a part of the plan’s network. Some plans will designate different levels of hearing aids and give you a copay amount for each level. For instance, you might have a $1,000 copays on a hearing aid that costs $3,000. Other plans may offer you a reimbursement amount per ear and then leave it up to you to determine if you want to spend out-of-pocket beyond the allotted amount.
Hearing coverage is very difficult to get (outside of a Medicare Advantage plan) so those on Original Medicare are usually out of luck. Hearing aids are expensive and private insurers are leery of offering hearing benefits. They know doing so would attract only people needing hearing aids, which wouldn’t make good economic sense. It would be akin to selling flood insurance to people who live on boats.