Over the past couple of years, dental and vision benefits have been added to many Medicare Advantage plans. The extra dental and vision benefits generally have no additional monthly premium. The question has always been, from the perspective of the Medicare beneficiary, if the dental and vision coverage is a good value or a marketing gimmick. These added benefits can be both hollow selling point and valuable benefit depending on the needs of the enrolled member.
Dental & Vision Medicare Benefit: Value or Gimmick?
A health plan without your preferred doctors is not health insurance. Similarly, dental or vision benefits without it being accepted by your preferred dentist or optometrist is just a selling gimmick. Consequently, before favoring a Medicare Advantage plan because of the dental or vision benefits embedded in the plan, it is important to learn about the network of providers and if your preferred doctor is in the network.
If the dental coverage is an HMO structure, there will be fewer dentists in the network. Because most Medicare Advantage plan are HMOs, the dental benefits will be with HMO dentists. Unfortunately, it can be difficult with some plans to actually find the dental network search option tools. The dental coverage is usually administered by a third-party and that party may have a bare bones website with a dysfunctional provider search tool.
Can You Find a Dentist or Optometrist?
Vision coverage is usually easier to access under a Medicare Advantage plan. However, you must still know the underwriter or third-party administrator. You can then contact your optometrist and ask if they accept the third-party vision coverage offered through the Medicare Advantage plan. If the third-party administrator is not listed in the Medicare Advantage summary of benefits, (common administrators are VSP, EyeMed, Careington), you will need to call the plan to determine the administrator of the benefit.
You may find the providers are big box stores or nationwide chain optometrists. There is nothing wrong with these providers. The cynical perspective is that some providers participate with discount dental or optometry services in order to drive traffic into their stores and sell you something more expensive.
What Is Covered?
In addition to the dentists and optometrists, coverage benefits can be thin. In other words, some dental benefits of the Medicare Advantage plan only cover cleanings, x-rays, and exams. There may be no coverage for dental services such as a filling, crown, root canal, or implants. The vision benefit may have only a low copayment for vision exams and nothing for frames or lenses. For some people, the bare minimum is good enough and a good value.
Many Medicare Advantage plan sponsors also offer a more comprehensive PPO dental plan for an additional monthly premium. The dental plans are closer to a traditional dental insurance plan that covers routine cleanings, exams, x-rays, minor and major restorative services. Most of the add-on plans will have a $1,000 to $1,500 maximum annual benefit.
The downside to these plans is that they are not portable. If you leave the Medicare Advantage plan, you may not be able to keep the dental coverage. Sometimes the Medicare Advantage plan sponsor decides not to offer their plans the next year in your county. This means you lose your health and dental coverage.
Portable Dental and Vision Insurance
A better strategy is to have your own dental and vision plans that are not tied to any Medicare Advantage plan. The monthly rates for stand alone dental or vision plans are competitive with what the Medicare Advantage plan sponsors offer. Then, regardless of whether you stick with your Medicare Advantage plan or leave it the next year, your dental or vision plans are not affected.
The extra dental and vision benefits in the Medicare Advantage plans can be important and valuable for some Medicare beneficiaries. But they are limited in their scope of coverage and it may be hard to find a provider who accepts the insurance. Carefully examine the dental and vision benefits of any Medicare Advantage plan. Don’t enroll in a Medicare Advantage just because it has dental and vision coverage. If you want comprehensive dental or vision insurance, consider enrolling in a stand alone plan that is portable.