Does Medigap cover dental and vision care?

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 are supplemental insurance plans that cover some of the out-of-pocket costs not paid by Original Medicare. The 10 standardized Medigap plans provide up to 9 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.

Exceptions in Original Medicare

There are a few circumstances when Original Medicare might cover dental-related visits. 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, “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.”

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, according to the Medicare.gov vision coverage rules, Medicare Part B does cover some preventative and diagnostic eye exams for the following:

  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 3 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%. The Medicare Part B deductibles and co-payments still apply. If you have a Medigap insurance policy that includes Medicare Part B deductible and co-payment 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. If you need routine vision or dental care, you can apply for a private vision insurance or dental insurance plan. Some Medicare Advantage plans, which are different than Medicare Supplement insurance and Original Medicare, include dental and vision coverage.

 

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