Dental, Vision and Hearing Coverage: What Medicare and Health Plans Leave Out

Short answer: Original Medicare generally does not cover routine dental care, routine eye exams for glasses, most eyeglasses and contacts, hearing aids, or exams to fit hearing aids. The exceptions are narrow, such as dental care tied to certain covered medical treatments and one pair of standard eyeglasses after cataract surgery with an intraocular lens. Some Medicare Advantage plans add dental, vision or hearing extras, and ACA Marketplace plans must make children’s dental and vision available but not adults’. Many people fill the gap with a standalone dental, vision or hearing plan, or buy over-the-counter hearing aids for perceived mild to moderate hearing loss.

What Original Medicare Leaves Out

Original Medicare means Part A (hospital insurance) and Part B (medical insurance), the coverage run by the federal government. It was built around doctors and hospitals, and everyday care for teeth, eyes and ears mostly falls outside it. According to Medicare.gov, in most cases you pay all costs for:

Routine dental, vision and hearing care under Original Medicare (Medicare.gov coverage pages)
Type of care	Original Medicare
Routine cleanings, fillings, tooth extractions	Not covered in most cases
Dentures and implants	Not covered in most cases
Routine eye exams (refractions) for glasses or contacts	Not covered
Eyeglasses and contact lenses	Not usually covered
Hearing aids and exams for fitting them	Not covered
Diagnostic hearing and balance exams ordered by your provider	Covered by Part B

A Medicare Supplement (Medigap) policy does not change this picture. Medigap helps pay your share of costs in Original Medicare, like copayments, coinsurance and deductibles. Because routine dental, vision and hearing aids are not Original Medicare benefits to begin with, there is usually no share for Medigap to pay. If you are weighing the two main routes, our guide to Medicare Advantage vs. Medigap in Idaho covers the bigger trade-offs.

The Narrow Exceptions

Medicare does pay for some care in these areas, but only in specific situations. It helps to know them so you are not surprised either way.

Dental care linked to a covered medical treatment. Medicare may cover an oral exam and dental treatment before a heart valve replacement or a bone marrow, organ or kidney transplant; a procedure such as a tooth extraction to treat a mouth infection before cancer treatment like chemotherapy; treatment for a complication during head and neck cancer treatment; and certain dental exams and infection treatment before and during dialysis for people with End-Stage Renal Disease.
Dental care during a hospital stay. Some dental services may be covered when you are admitted as a hospital inpatient for the procedure, because of an underlying medical condition or the severity of the procedure.
Eyewear after cataract surgery. Part B covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants an intraocular lens. You pay 20% of the Medicare-approved amount after the Part B deductible, plus any extra cost for upgraded frames, and the supplier must participate in Medicare.
Diagnostic hearing and balance exams. Part B covers these when your doctor or other provider orders them to find out whether you need medical treatment. You can also see an audiologist once every 12 months without an order for certain non-acute hearing conditions.

Notice the pattern: Medicare pays when the care is part of treating a medical problem, not for routine upkeep like cleanings, new glasses or hearing aids.

Medicare Advantage Extras

With Medicare Advantage (Part C), you join a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage, and in many cases you can only use doctors in the plan’s network. Medicare.gov notes that some Medicare Advantage plans offer extra benefits that Original Medicare does not cover, like vision, hearing or dental.

The key word is some. Whether a plan includes these extras, how much it pays, how often you can use the benefit and which dentists, eye doctors or hearing providers you can see all vary by plan and by county. Before you choose a plan for its extras, read the plan’s Evidence of Coverage or benefit summary, and confirm your providers are in its network. Our guide on checking your doctors and drugs in a Medicare plan walks through how to do that, and our Medicare Advantage page explains how we compare plans across Idaho.

ACA Rules for Dental and Vision

If you are under 65 and buy coverage through the Marketplace (in Idaho, that is Your Health Idaho), the rules depend on age. Under the Affordable Care Act, every Marketplace plan must cover a set of essential health benefits, the minimum categories of care a plan has to include.

Children. HealthCare.gov lists pediatric services, including oral and vision care, as an essential health benefit. For anyone 18 or younger, dental coverage must be available, either inside a health plan or as a separate dental plan, though you do not have to buy it.
Adults. Adult dental and vision coverage are not essential health benefits. Health plans do not have to offer adult dental coverage.

In the Marketplace, some health plans include dental, and in some cases separate dental plans are offered with their own premium. HealthCare.gov notes you cannot buy a Marketplace dental plan unless you are buying a health plan at the same time, and that separate dental plans can have waiting periods for adults. Our guide to the health insurance marketplace in Idaho covers how enrollment works.

How Standalone Dental Plans Work

A standalone dental plan is a separate policy you buy just for dental care, outside of Medicare or your health plan. Designs differ by insurer, but most share the same building blocks:

Service tiers. Care is usually grouped as preventive (cleanings, exams, X-rays), basic (such as fillings) and major (such as crowns, bridges or dentures). Each tier is typically paid at its own percentage, with preventive care paid at the highest level and major work at the lowest. The exact percentages are in the plan’s schedule of benefits.
Deductible. The amount you pay before the plan starts paying, often applied to basic and major services rather than preventive care.
Annual maximum. The most the plan will pay in a benefit year. Once it is reached, you pay the rest. This number shapes the plan’s real value more than the premium does.
Waiting periods. Many plans pay for preventive care right away but make you wait before covering basic or major work. HealthCare.gov warns that you pay premiums during the waiting period even though those services are not yet covered.
Network or any dentist. Some plans pay best, or only, when you use dentists in their network. Others let you see any dentist but may pay based on a set fee schedule, which can leave you owing the difference.

If you already know you need a crown or dentures, the waiting period and annual maximum matter most. If you mostly want cleanings and checkups, a plan with strong preventive coverage and no waiting period on those services may be a better match. Rural Idahoans should also check how many network dentists are within a reasonable drive.

Vision Plans and Discount Plans

A vision insurance plan usually works in two parts: a covered routine eye exam, and a materials allowance, a set dollar amount toward frames, lenses or contacts within a time period. If you choose eyewear that costs more than the allowance, you pay the difference.

A discount plan is different. It is not insurance. You pay a membership fee and get reduced prices from participating providers, but the plan itself does not pay claims. Discount plans can be useful, but read what you are buying: the savings only apply at participating locations, and there is no insurance benefit behind them.

Remember that medical eye care is a separate matter. For example, Medicare Part B may cover cataract surgery under its medical benefits. A vision plan is about routine exams and eyewear.

Hearing Aids: OTC vs. Prescription

Since October 17, 2022, the FDA has recognized a category of over-the-counter (OTC) hearing aids. According to the FDA, OTC hearing aids are intended for adults 18 and older with perceived mild to moderate hearing loss, and you can buy them in a store or online without a medical exam, prescription or fitting by an audiologist. They let the user adjust and customize the settings.

A prescription hearing aid is any hearing aid that is not OTC. The FDA says these are available only through a licensed hearing health care professional, who programs the device to your level of hearing loss, and they may be appropriate for all levels of hearing loss. OTC devices are not meant for severe or profound hearing loss, so if you suspect your loss is more serious, the FDA advises seeing a licensed hearing professional.

Original Medicare does not pay for either kind. Some Medicare Advantage plans and some standalone plans include a hearing benefit, so check how it works: whether it is an allowance, which providers you must use, and how often it renews. Before buying any hearing aid, the National Institute on Deafness and Other Communication Disorders suggests asking about the total cost, the trial period (it notes most manufacturers allow a 30 to 60 day trial for a refund), which fees are nonrefundable, and how long the warranty lasts. The FDA also requires OTC packaging to state the manufacturer’s return policy.

How to Compare Your Options

List what you expect to need. Cleanings only, or a crown or dentures soon? New glasses every year? Hearing aids in the next year or two?
Start with what you already have. Check whether your Medicare Advantage plan, employer plan or Marketplace plan already includes any of these benefits, so you do not pay twice.
Check waiting periods against your timing. A plan that will not cover major dental work for a while may not help with a need you have now.
Compare annual maximums and allowances, not just premiums. Add up a year of premiums and compare it with what the plan would realistically pay.
Confirm your providers. Ask your dentist, eye doctor or hearing provider which plans they take before you enroll.
Read the exclusions. Look for limits on how often a service is covered and any restrictions on frames, lenses or hearing devices.

We compare standalone dental, vision and hearing plans from several carriers for Idahoans in all 44 counties, by Zoom, by phone or at our Idaho City office. See our dental, vision and hearing coverage page for what we offer. If a hospital stay is your bigger worry, our guide to hospital indemnity insurance covers another common supplemental plan.

Want help filling the dental, vision and hearing gap?

Tell us what your teeth, eyes and ears are likely to need this year, and we will lay out the plan options side by side in plain words.

Request a free comparison Call 208-350-9933

Frequently Asked Questions

Does Original Medicare cover dental care?

In most cases, no. Medicare.gov says Original Medicare does not cover routine cleanings, fillings, tooth extractions, dentures or implants. It may cover certain dental services tied to a covered medical treatment, such as an oral exam before a heart valve replacement or an organ transplant, or dental services during a covered inpatient hospital stay.

Does Medicare pay for glasses or hearing aids?

Usually not. Original Medicare does not cover routine eye exams for glasses or contacts, most eyeglasses and contact lenses, hearing aids, or exams for fitting hearing aids. The main exception for eyewear is one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants an intraocular lens.

Do Medicare Advantage plans include dental, vision and hearing?

Some do. Medicare.gov notes that some Medicare Advantage Plans offer extra benefits that Original Medicare does not cover, like vision, hearing or dental. What is included, how much the plan pays and which providers you can use vary from plan to plan, so read the plan’s own benefit details before you enroll.

Do ACA Marketplace plans cover adult dental and vision?

Not necessarily. HealthCare.gov lists pediatric services, including oral and vision care, as an essential health benefit, but adult dental and vision coverage are not essential health benefits. Health plans do not have to offer adult dental coverage, so many adults add a separate dental plan.

What is a waiting period on a dental plan?

A waiting period is a stretch of time after you enroll before the plan pays for certain services. HealthCare.gov warns that during a waiting period you still pay monthly premiums, but the plan will not cover those services until the waiting period ends. Ask the insurance company for the waiting period on each type of service before you enroll.

Who can buy over-the-counter hearing aids?

The FDA created the over-the-counter hearing aid category for adults 18 and older with perceived mild to moderate hearing loss. You can buy them in a store or online without an exam or prescription. They are not intended for severe or profound hearing loss, and people under 18 need prescription hearing aids.

Coverage pages for this topic: Hospital Indemnity · Dental, Vision & Hearing. Other topics in the Learning Center: Medicare, Health Insurance (ACA), Life Insurance, Final Expense, Annuities, Long-Term Care, Disability Insurance, Short-Term Medical, Travel Insurance.

Sources

This guide does not quote premiums, annual maximums, allowances or waiting period lengths, because they vary by plan, insurer and benefit level. Check each plan’s schedule of benefits for its exact figures. This guide is general education, not individual advice.