One of the most common surprises new Medicare beneficiaries face is discovering what Original Medicare does not cover. Three of the most significant gaps: routine dental, vision, and hearing care. Understanding these gaps — and how to fill them — is essential planning.
Original Medicare's Dental Coverage (It's Minimal)
Medicare Part A covers dental care only in very limited circumstances — for example, if you need jaw surgery as part of a covered hospital procedure, or if dental extraction is medically necessary before cardiac surgery. Routine dental care — cleanings, fillings, extractions, dentures, crowns — is not covered by Original Medicare.
For most retirees, this means paying out of pocket or purchasing a standalone dental plan. Average dental costs in retirement can easily exceed $1,000–$2,000 per year for basic care, and much more if significant work is needed.
Vision: Limited to Medically Necessary Care
Original Medicare Part B covers eye exams related to medical conditions like glaucoma, diabetic retinopathy, and macular degeneration. But it does not cover routine annual eye exams for glasses or contacts, nor does it cover eyeglasses or contact lenses — with one narrow exception: following cataract surgery.
Hearing: Nothing Routine
Original Medicare covers diagnostic hearing and balance exams if your doctor orders them to diagnose a condition — but it does not cover routine hearing exams, hearing aids, or fittings. Given that hearing aids can cost $2,000–$7,000 per pair and aren't a "luxury" for many older adults, this is a significant gap.
How Medicare Advantage Plans Fill the Gap
This is one of the primary reasons many beneficiaries choose Medicare Advantage. Most MA plans include some level of dental, vision, and hearing benefits that Original Medicare doesn't offer:
- Dental: Many plans cover preventive care (cleanings, X-rays) at 100%, and some include basic or comprehensive restorative coverage — fillings, crowns, extractions, even dentures — up to an annual maximum.
- Vision: Routine eye exams and an annual allowance for frames or contacts are common. Some plans include discounts on LASIK.
- Hearing: Many plans offer a hearing aid benefit — a dollar allowance every 1–3 years — through a network of audiologists or a hearing aid company.
The Trade-Off
Medicare Advantage dental, vision, and hearing benefits are real — but they vary enormously by plan and by county. A plan in Florida may offer $2,500 in annual dental benefits; the same carrier's plan in Minnesota may offer $1,000. Benefits can change from year to year. It's critical to verify what a specific plan covers in your area before enrolling based on extra benefits alone.
Standalone Dental Plans
If you prefer Original Medicare with a Medigap supplement, standalone dental plans (not through Medicare) are also available. Premiums typically range from $30–$60/month for preventive and basic coverage.
Want help comparing the dental, vision, and hearing benefits available in your ZIP code? Call us at (530) 395-5309 or fill out our contact form. We'll run a full comparison for your area.