Teeth, eyes and ears: the line Medicare draws

Part B covers dental work that treats a medical condition, such as oral surgery ahead of radiation or a jaw repaired after an accident. Cleanings, fillings, crowns, dentures and routine extractions are outside the benefit.

Vision follows the same reasoning. Exams and treatment for eye disease are covered, including annual diabetic retinopathy screening and glaucoma testing for higher-risk patients. A routine refraction for glasses, the lenses themselves, or contacts are not.

Hearing draws the narrowest line of the three. Diagnostic hearing exams ordered by a physician to determine whether treatment is needed are covered. Hearing aids and the fittings for them are excluded.

Teeth, eyes and ears are exactly where spending tends to appear after 65, and the exclusion is easy to skim past in a summary of benefits. Someone who carried employer dental coverage for thirty years naturally assumes it continued. It did not, and a single crown can exceed a year of premiums on a supplemental policy.

There is a second surprise in dental work that precedes major medicine. Transplant and cardiac programs often require clearance, and there government Medicare may help with the medical side while your dentist bills separately.

An Advantage plan is the first. Many include a dental allowance, a vision benefit and an over-the-counter hearing credit, and roughly two thirds of Advantage enrollees have some dental benefit. Read the annual maximum and any waiting period before assuming it is generous.

A stand-alone dental, vision or hearing policy is the second, purchasable beside government Medicare or beside an Advantage plan. These are indemnity-style products with annual caps and waiting periods for major work, and they tend to be the most predictable way to cover routine care.

A discount plan is the third. It is not insurance, it negotiates a reduced rate with participating providers, and it will not cap your exposure. It can still work as a bridge when you have a dentist you trust and modest needs.

A $1,500 maximum with no waiting period is worth more than a $3,000 maximum you cannot touch for a year. Read the two numbers together.

Already in an Advantage plan you like? Read its dental and vision booklet before buying anything else. On government Medicare with a supplement? A stand-alone dental policy plus some care with hearing costs is usually the simplest route.

And when a dentist presents a large treatment plan, ask for the predetermination in writing before the first appointment. That document is the difference between a plan allowance and an invoice.