Is dental and vision covered under medicare

Q: Why is dental care not covered by Medicare?

Simply put, for a long time, dental work wasnt considered important enough to be covered by Medicare due to a lack of information and resources. The U.S. Centers for Medicare & Medicaid Services was established in 1965, and since then, little to no changes have been made to offer dental coverage.

Q: Does Medicare Part B cover vision?

Original Medicare‡ Parts A and B do not cover vision care, except in certain circumstances. For example, Part B partially covers eye exams if youre at higher risk for eye complications such as glaucoma. Medicare also covers some medically necessary eye surgeries, such as cataract removal.

Dental services

Medicare doesn't cover most dental care, procedures or supplies, such as cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. 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 inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isn't covered.

Table of Contents Show

Dental services
Eye exams and eyeglasses/contact lenses
Eyeglasses and contact lenses
Hearing exams and hearing aids
Can I add vision and dental to my Medicare?
Why is dental care not covered by Medicare?
Does Medicare Part B cover vision?

Note: Some Medicare Advantage plans (Part C) offer extra dental benefits. Be sure to contact the plan for more information.

Eye exams and eyeglasses/contact lenses

Eye exams

Medicare doesn't cover routine eye exams (sometimes called "eye refractions") for eyeglasses or contact lenses. Medicare Part B (medical insurance) covers some preventive and diagnostic eye exams:

Yearly eye exam (covers an exam by an eye doctor if you have diabetic retinopathy)
Glaucoma tests (covers people at high risk for glaucoma)
Macular degeneration (covers some diagnostic tests and treatment)

Eyeglasses and contact lenses

Generally, Medicare doesn't cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B (Medical Insurance) helps pay for corrective lenses (one pair of eyeglasses or one set of contact lenses).

Note: Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).

All people with Part B are covered. Your costs in Original Medicare are:

You pay 20% of the Medicare-approved amount for one pair of eyeglasses or one set of contact lenses after each cataract surgery with an intraocular lens.
Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).
You pay any additional costs for upgraded frames.
You pay 100% for non-covered services, including most eyeglasses or contact lenses. The Part B deductible applies.

Note: Some Medicare Advantage plans offer extra vision benefits. Be sure to contact the plan for more information.

Hearing exams and hearing aids

Medicare doesn't cover routine hearing exams, hearing aids, or exams for fitting hearing aids. Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment. All people with Part B are covered.

Your costs in Original Medicare:

You pay 100% for routine exams and hearing aids.
You pay 20% of the Medicare-approved amount for the doctor's services for covered exams, and the Part B deductible applies.
In a hospital outpatient setting, you also pay the hospital a copayment.

Note: Some Medicare Advantage plans offer extra hearing benefits. Be sure to contact the plan for more information.

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Dental care is excluded from Medicare coverage.

Medicare does not cover dental services that you need primarily for the health of your teeth, including but not limited to:

Routine checkups
Cleanings
Fillings
Dentures (complete or partial/bridge)
Tooth extractions (having your teeth pulled) in most cases

If you receive dental services, you will be responsible for the full cost of your care unless you have private dental coverage or are utilizing a low-cost dental resource. Again, Medicare will not pay for or reimburse you for dental services you receive primarily for the health of your teeth.

Note: Some Medicare Advantage Plans cover routine dental services, such as checkups or cleanings. If you have a Medicare Advantage Plan, contact your plan to learn about dental services that may be covered.

While Medicare does not pay for dental care needed primarily for the health of your teeth, it does offer very limited coverage for dental care needed to protect your general health, or for dental care needed in order for another Medicare-covered health service to be successful. For instance, Medicare may cover:

An oral examination in the hospital before a kidney transplant
An oral examination in a rural clinic or Federally Qualified Health Center (FQHC) before a heart valve replacement
Dental services needed for radiation treatment for certain jaw-related diseases (like oral cancer)
Ridge reconstruction (reconstruction of part of the jaw) performed when a facial tumor is removed
Surgery to treat fractures of the jaw or face
Dental splints and wiring needed after jaw surgery

It is important to know that while Medicare may cover these initial dental services, Medicare will not pay for any follow-up dental care after the underlying health condition has been treated. For example, if you were in a car accident and needed a tooth extraction as part of surgery to repair a facial injury, Medicare may cover your tooth extraction—but it will not pay for any other dental care you may need later because you had the tooth removed.

Medicare also covers some dental-related hospitalizations. For example, Medicare may cover:

Observation you require during a dental procedure because you have a health-threatening condition

In these cases, Medicare will cover the costs of hospitalization (including room and board, anesthesia, and x-rays). It will not cover the dentist fee for treatment or fees for other physicians, such as radiologists or anesthesiologists. Further, while Medicare may cover inpatient hospital care in these cases, it never covers dental services specifically excluded from Original Medicare (like dentures), even if you are in the hospital.

If you need dental care, look into resources or other forms of insurance that may help pay for dental services. You can also use FAIR Health’s consumer cost lookup tool to get an estimate for the amounts dental professionals usually charge in your area for different services.

Can I add vision and dental to my Medicare?

Medicare Advantage (Part C) plans can offer coverage for dental and vision health items in addition to also offering the same coverage as Original Medicare. Most also include prescription drug coverage as well as other benefits such as hearing health coverage and gym memberships.

Why is dental care not covered by Medicare?

Simply put, for a long time, dental work wasn't considered important enough to be covered by Medicare due to a lack of information and resources. The U.S. Centers for Medicare & Medicaid Services was established in 1965, and since then, little to no changes have been made to offer dental coverage.

Does Medicare Part B cover vision?

Original Medicare^‡ Parts A and B do not cover vision care, except in certain circumstances. For example, Part B partially covers eye exams if you're at higher risk for eye complications such as glaucoma. Medicare also covers some medically necessary eye surgeries, such as cataract removal.