TONI SAYS: Losing employer COBRA with dental benefits and enrolling in Medicare…What do I do?

By Toni King

Toni: I will be eligible for Medicare in July and am now receiving cancer treatment from MD Anderson. I am currently on my ex-employer’s COBRA and searching for dental care when I go on Medicare in July. The only dental/vision plans I am finding are in Medicare Advantage plans, but MD Anderson has advised me to not go in that direction because many Medicare Advantage plans are no longer accepted at their facility.

Is there a dental plan that Medicare offers? Please advise. Tammy from Alvin, TX

Tammy: “What’s NOT Covered by Part A & Part B?” is explained in the Medicare & You handbook. It states… “Original Medicare does not cover everything and if you need certain services that Medicare Part A and Part B doesn’t cover, you will have to pay for them yourself unless:”

  • You have other coverage (including Medicaid) to cover the costs.
  • You are in a Medicare Advantage Plan that covers these services.

Some of the items and services that Original Medicare does not cover include:

  • Most dental care.
  • Eye examinations related to prescribing glasses.
  • Dentures.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine Physical Exams.
  • Hearing aids and exams for fitting them.
  • Long-term care.
  • Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care).

Covered items or services you receive from an opt out doctor or doctor not accepting Medicare.

Since Medicare does not cover dental, I would recommend that you talk to your dentist and see which dental insurance plans he/she prefers.

There are 2 types of dental plans:

1) Traditional or indemnity dental insurance plans which is generally higher in premium, and the preventive services are usually covered at 100%, basic restorative is generally covered up to 80% and major procedures at 50%. Recently, new dental plans have been released which help with the costs of dental claims such as fillings, crowns, and root canals. A major surprise is that these plans begin immediately with no wait. Many of the older traditional/indemnity dental plans may have a wait for services such as fillings, root canals, bridges, crowns, etc.

2) Discount dental plans are generally less expensive than traditional dental plans. These plans provide a discount for services, but your dentist must be part of the plan’s network and agree to give the dental discount.

In the Medicare & You handbook, it talks about eyeglasses (after cataract surgery) which is a limited benefit because Medicare will cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. The Medicare Part B deductible will apply for the cataract surgery, and you will pay the 20% of the Medicare-approved amount unless you are enrolled in a Medicare supplement then your out of pocket may be low.

Medicare defines purchasing glasses and hearing ais as an elective. Which means you will have to pay for them. “Medicare covers the hearing exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay the 20% of the Medicare-approved amount and the Part B deductible applies.”

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