Most of us know that we are eligible for Medicare at age 65 and that, in most cases, we’ll need to sign up for Part A and Part B (also known as Original Medicare) by the time we retire. After the first two parts of Medicare, the coverage you need can be less clear. Should you get Part C? What about Part D? What do those parts even get you?
If you’ve been keeping up with your insurance policies while working, you’re likely used to having a regular health insurance plan and separate dental and vision policies. However, Medicare does not have separate dental and vision offerings, often leaving people wondering how they will replace their workplace coverage in retirement. Dental and vision coverage is important to keep up in the long run since it can help prevent larger issues that could take away from your quality of life, such as losing teeth or coping with blurring vision.
In this post, we look at how Medicare works with dental and vision coverage so you can better understand the policies that are right for you in retirement.
Original Medicare’s Dental and Vision Coverage
To understand how dental and vision coverage can benefit you, we need to look at what Original Medicare provides. We discuss Original Medicare’s coverage more in our blog post “The True Cost of Medicare,” but in short, think of Original Medicare as coverage for some reactive procedures but not any preventative dental and vision care.
Original Medicare may cover dental work that is inextricably linked to the success of another necessary medical treatment, like an oral exam before heart surgery, but not your semiannual trip to the dentist for a cleaning. For vision, Original Medicare may cover corrective lenses after cataract surgery or glaucoma screenings for high-risk individuals, but it won’t pay for your routine eye exams.
While Original Medicare does provide for some dental and vision needs, its coverage is limited to less common procedures and excludes the preventative, routine visits that most of us think of when choosing dental and vision policies. To acquire dental and vision coverage closer to what you were used to while working, we’ll have to look at Medicare Part C.
Medicare Advantage Plans (Part C)
Medicare Advantage plans (otherwise known as Medicare Part C) can be purchased to fill the gap in Original Medicare’s dental and vision coverage. Depending on your preferences and geographic location, several Part C options are available that may look familiar to you, such as preferred provider organization (PPO) and health maintenance organization (HMO) plans. Throughout all of them, you will see more coverage for some services, such as:
Routine dental and vision exams
Routine dental, vision, and hearing care (e.g., dentures, glasses, hearing aids)
Most Part C plans cover routine exams and preventative services, but not every plan provides for procedures like fillings and root canals. You may need to look at supplemental benefits in your Part C plan to cover these procedures, which will increase the cost of your policy.
Medicare Advantage plans work like most other health insurance in that they have deductibles, co-pays, and annual out-of-pocket maximums. Make sure to review the network of any policy you choose since receiving out-of-network care usually results in higher costs. Of course, any Advantage plan will have a premium attached to it, so consider if it aligns with your anticipated needs before applying for a policy.
It may look like a no-brainer to buy a Medicare Advantage plan to round out your retiree health insurance, but keep in mind that these plans do not make sense for everyone. Some people may be disqualified from other retiree health insurance they would otherwise be eligible for if they purchase Part C, which we will discuss later in this post. Additionally, if you move, you may need to change plans since some are offered in only specific regions. It would be a good idea to look a few years into the future when buying a plan so you’re not caught unaware if or when you move.
Supplemental Insurance Options
Other Medicare supplement plans are available if Medicare Advantage doesn’t sound enticing. You may have heard of medigap (Medicare supplemental insurance). This standardized coverage is designed to fill the gaps in Original Medicare.
Original Medicare pays only ~80% of covered Part B health care services, so medigap policies are meant to cover the remaining 20% of costs you would otherwise pay out of pocket. These costs include co-payments, coinsurance, and deductibles. Unfortunately, while the plans sound helpful, they do not do much to provide for dental and vision care.
You may wonder if any non-Medicare options are available—and there are! Insurance providers you may be familiar with, like Cigna and Delta, offer stand-alone dental and vision policies for retirees. These can be great options to cover specific medical needs without relying on Medicare. However, you’ll want to keep an eye on the premiums since they can be more costly than Medicare plans.
As with all health insurance plans, make sure you review the network restrictions and exclusions before purchasing.
Factors to Consider When Deciding
Now that you understand what is available, you can consider which option is the best for you. As with all medical insurance decisions, your medical needs are the first factor to consider. Do you expect to use dental and vision benefits often? Do you anticipate needing them on more of a routine, preventative basis or for irregular intensive procedures?
Once you’ve considered your health, the next factor is the available plans and benefits. Would a Medicare Advantage plan be better suited for your dental and vision needs along with the other supplemental medical care it provides? Would you rather focus on private, stand-alone policies that provide you with the dental and vision care you need and nothing more? Or do you feel comfortable with Original Medicare coverage and see no need to add a supplemental policy?
Don’t forget to review premiums, deductibles, co-pays, and annual limits to make sure you’ll get the most out of any policy you choose. You’ll want to check on the availability of local providers under specific plans and how that may change if you move a few years down the road, lest you unexpectedly need to change your coverage.
Finally, check with your employer to see if they offer supplemental retirement medical insurance benefits. These plans tend to work similarly to a Medicare Advantage plan and can be provided to you at a lower-than-market cost if your employer covers a portion of your premium in retirement.
Bear in mind that you typically cannot have both a Medicare Advantage plan and supplemental retiree medical insurance through your employer, as they both act as supplemental policies. Additionally, enrolling in Medicare Part C can often permanently disqualify you from the employer plan.
Key Takeaways
Insurance, especially Medicare, is not an enjoyable discussion for most of us. It is, however, important. Dental and vision costs don’t get thrown away once you have braces and contacts, and can instead increase with age. While you may have been worrying about your teeth being straight for the first half of your life, you may need to worry about tooth decay in the second half. Even if you have good vision now, conditions such as diabetic retinopathy commonly develop as we age.
There are insurance options that can help mitigate the cost of your needs, and it’s better to analyze which would best fit your goals before you have an emergency. The earlier you secure coverage that provides you with the proactive care you need, the more likely you will avoid reactive procedures and bigger issues years into the future. If you’re close to retirement or otherwise applying for Medicare, I strongly recommend you look at your options today.
Any supplemental Medicare plan comes with its pros and cons, and can have long-term implications financially and medically. Consider consulting with a financial advisor or insurance specialist to make an informed decision that fits your needs now and in the future.
Discuss your situation with a fee-only financial advisor.
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