Here is what you need to know
As we have said many times, Medicare is great insurance but it doesn’t cover everything.
Seniors losing their group or employer coverage and joining original Medicare quickly learn that Medicare doesn’t cover their routine dental, vision or hearing expenses.
These 3 categories have a real impact on quality of life for many seniors. As we get older most of us will experience one or more of these deteriorate and have an impact on our day-to-day lives.
Medicare will often cover dental, vision or hearing in cases related to injury or disease but generally not for routine care and checkups.
For that type of coverage seniors must go shopping for additional coverage.
There are 2 plan designs available for routine dental, vision and hearing coverage. The first one is indemnity plans, also referred to as reimbursement plans. These plans pay you a percentage of what you pay for services up to a set benefit amount per year.
The percentage of reimbursement often increases during the first 3 years. There are generally no networks so you can go to any provider you choose. But since there are no networks, you don’t get any network re-pricing of services. These plans may have waiting periods before you can submit claims for certain services.
The second plan design is a network based one. This sort of plan is what many seniors are used to coming from employer or group plans. There is a provider network, and depending on the plan, if you stay in-network you will save money because your services will be re-priced. If you are allowed to go out of network then you will not get re-pricing of services.
Network based plans all have some annual maximum benefit level. As you use services you are charged a copayment or small amount or percentage of the cost of the service rendered. With network based plans even after you use up your annual benefit amount you will still get re-pricing of services if you stay in-network.
There are several dental and vision indemnity or reimbursement plans on the market. But your choices diminish when looking for a plan that covers all 3.
Network based plans can be purchased from many companies. Plans often include dental coverage but have an available vision rider that can be added.
One popular way seniors can also get routine dental, vision and hearing coverage is through a Medicare Advantage plan.
Most of these Advantage plans include some basic dental, vision and even hearing benefits. These benefits can be in the form or copayments up to a certain amount per year or a flat dollar amount the plan will reimburse you for.
If you would like more information on what your available choices are and the cost of plans give us a call. We would be happy to provide you with quotes or guidance.