Check Your Medicare Plan To See What Is Covered

Question: Does my Medicare Insurance cover hearing aids, dental procedures, and eye wear?

Answer: There are many insurance companies running ads talking about those extra benefits they are offering. This type of coverage depends on the Medicare coverage you have.

In most situations, Original Medicare does not cover the cost of hearing aids, glasses and dental work. Original Medicare is a health insurance product, which means that all of your coverage must be based on a medical problem or diagnoses.

Medicare covers the cost of an audiological evaluation, including tests of tinnitus (perception of noise in the ear and head), auditory processing and osseointegrated devices or cochlear implants. Cochlear implants, are appropriate for patients with ear malformations and when hearing aids are medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe hearing loss or surgery. This situation is rare.

Hearing aids are considered “audiological treatment,” and not covered by Original Medicare. If you have a disorder of the auditory systems, however, you have coverage for speech-language pathology services.

When you have Medicare and have enrolled into a Medicare Advantage (MA) plan, HMO, PPO, or PFFS plan, you may have limited coverage of hearing aids. For example, some plans give you an allotment for your hearing aid, some pay a specific dollar amount, and some pay up to 50% at an appropriate vendor. With a MA plan, be sure to call about the plan prior to making your appointment, so you use the preferred vendor and avoid the most out-of-pocket expense.

Employee/retiree plans can cover hearing aids, but this is an item that you will have to pay for yourself.

When shopping for hearing aids, you are not comparing apples to apples. Each type has different benefits. A expensive or small device may not be the best. See an audiologist who can give you diagnosis, and recommend a device.

For eye care, Medicare will cover glaucoma, cataracts, injuries, infections or macular degeneration.

After cataract surgery, your vision may change and you may not need glasses.

If you still need corrective lenses after your surgery, Medicare will pay for the lens on the eye that had surgery and/or a standard frame. This is paid under Medicare Part B, so the deductible and co-pays apply.

Many MA plans, (HMO, PPO, and PFFS plan) give you additional coverage for glasses, such an allotment, or a specific dollar amount. This will not pay for the glasses, but it will help to offset your cost. With an MA plan, be sure to call the about the plan prior to getting your glasses to stay within the provider network and find what type of glasses/frame are covered.

Some employee/retiree plans that cover glasses. Be sure to contact your insurance provider and ask what is covered and how it is covered. In some situations you can get safety glasses with corrective lenses or other types of glasses.

Dental coverage is something that Original Medicare rarely covers. It is a relatively new added and highly advertised benefit for MA Plans. Most plans state they cover dental, but they may define that coverage as two free cleanings and one bite wing x-ray a year. This may be less coverage than you expect or need. Dental coverage should be researched thoroughly before selecting a plan.

It is important to remember that MA plans must give you at least the minimum that Medicare gives you.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 720-9797 or e-mail at SLM@lutheran-jamestown.org.


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