UNITED STATES—Toni, I will be eligible for Medicare in July and am now receiving breast cancer treatment from MD Anderson. I am currently on my ex-employer’s COBRA and searching for dental care when I go on Medicare in July. The only dental/vision plans I am finding are in Medicare Advantage plans, but MD Anderson has advised me to not go in that direction because many Medicare Advantage plans are no longer accepted at their facility. Is there a dental plan that Medicare offers? Please advise, Tammy from Alvin, TX.
Tammy: “What’s NOT Covered by Part A & Part B?” is explained on page 49 of the 2019 Medicare & You handbook. It states… “Original Medicare does not cover everything and if you need certain services that Medicare Part A and Part B doesn’t cover, you will have to pay for them yourself unless:”
■ You have other coverage (including Medicaid) to cover the costs.
■ You’re in a Medicare Advantage Plan that covers these services.
Some of the items and services that Original Medicare doesn’t cover include:
✘ Most dental care.
✘ Eye examinations related to prescribing glasses.
✘ Cosmetic surgery.
✘ Hearing aids and exams for fitting them.
✘ Long-term care. See page 50 for more information about paying for long-term care.
✘ Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care).
Since Medicare doesn’t cover dental, I would recommend that you talk to your dentist and see which dental insurance plans he/she prefers.
There are 2 different types of dental plans:
1) Traditional or indemnity dental insurance plans which is generally higher in premium and the preventive services are usually covered at 100 percent, basic restorative is generally covered up to 80 percent and major procedures at 50 percent. Many of the traditional/indemnity dental plans may have a wait for services such as fillings, root canals, bridges, crowns, etc.
2) Discount dental plans are generally less expensive than traditional dental plans. These plans provide a discount for services, but your dentist must be part of the plan’s network and agree to give the dental discount.
On page 38 of the Medicare & You handbook, it talks about eyeglasses (after cataract surgery) which is a limited benefit because Medicare will cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. The Medicare Part B deductible will apply for the cataract surgery and you will pay the 20 percent of the Medicare-approved amount unless you are enrolled in a Medicare supplement then your out of pocket may be low.
Medicare defines purchasing glasses as an elective. Which means you will have to pay for them.
Hearing aids are also considered elective, just like dental issues and glasses. “Medicare covers the hearing exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay the 20% of the Medicare-approved amount and the Part B deductible applies.”
Always ask your HR or benefits administrator if your dental, vision and hearing aid benefits are ancillary and can be an individual policy when you leave your employers or COBRA benefits. Group benefit plans are generally more comprehensive.
Is the maze of Medicare confusing you? Visit www.abbs4u.com and attend ABBS (American Baby Boomer Society) Medicare courses for more Medicare education.
If you are still confused and would like to discuss your specific Medicare circumstances email firstname.lastname@example.org and the Toni Says® team can help you.
Toni King, author of the Medicare Survival Guide® Advanced is giving a $5 discount on the Medicare Survival Guide® Advanced book and bundle packages as a Thank You for the Toni Says® newspaper article readers. Go to www.tonisays.com to purchase.