This week’s question
Why doesn’t Medicare include dental, vision, and hearing benefits? I’ve been reading that some Congresspeople are proposing they be covered by Medicare in the near future. What are your thoughts on this?
Answer
Medicare does pay for all medical conditions for ears, eyes, and mouth
First of all, please be advised that Medicare does pay for all medical conditions for the ears, eyes, and mouth. For example, an ear or eye infection, glaucoma, cataract, macular degeneration, a broken jaw that needs surgery, etc., are all be covered by Medicare.
The simple answer to why there hasn’t been coverage for those services is cost. A bill proposed in 2019 to cover comprehensive dental, vision, and hearing benefits had a price tag of $360 billion dollars over 10 years. Although it would be great if original Medicare came with these benefits, I’m afraid the cost would be passed on to consumers and taxpayers.
I’ve seen a proposed solution to partially or fully fund cosmetic dental, vision, and hearing with savings that would be created by allowing Medicare to negotiate prices directly with drug companies, something I think should have been done 10 years ago. I’ve made this statement in previous columns however. Good luck getting Big Pharma to willingly cut their profits, or getting rid of Pharmacy Benefit Managers (PBM’s), the middlemen and women in the distribution chain of prescription drugs who make billions of dollars in what is a very complex and opaque business.
Solvency Issues
Medicare already has solvency issues. According to a February 2021 Rueters article, “The Medicare trustees projected last year that the Hospital Insurance Trust Fund will become insolvent in 2024.” That is in regard to Part A of Medicare which is funded by the Medicare payroll tax. Part B, which would pay for dental, vision, and hearing benefits, is financed through a combination of government revenue (taxes) and enrollee premiums. So again, I predict there would have to either be additional taxes levied, a substantial increase in monthly Medicare Part B premiums, or both.
An average employer sponsored dental plan currently costs between $25-$30 per month and covers the following: Preventative services like cleanings and X-rays at 100%, Restorative services such as fillings, simple extractions, and periodontal at 80%, and major services such as crowns, root canals, partials, and dentures at just 50%. The maximum benefit that these dental plans pay is only $1,000 to $1,500 per year. Imagine what the cost would be if Medicare paid everything at 80% with no limit on the amount of benefits one can receive like they do for all Part B covered services. I’ve only once seen a dental plan that had no annual limit. It had a premium of $100 per month per person. Who is going to pick up that tab for the 80 million people who are projected to be on Medicare by 2030? Big Pharma? I certainly wish they would, but it’s just not going to happen. We’re taking about trillions of dollars, not billions with that many people on Medicare.
In addition, if Medicare Supplement companies were forced to cover the 20% that Medicare doesn’t pay, which is currently a requirement for all Part B covered services, those premiums would have to increase as well. We could be talking about an additional $1,000, $2,000, or more per year in premium costs for those on Medicare. That would be a huge burden on seniors whose incomes remain stagnant even as the cost of goods and services increase.
I’d personally rather not see Medicare get involved in offering these benefits because in the long run, I believe they would actually end up costing the average Medicare beneficiary more than if they purchased a private plan or paid for these services out of their own pocket. If they did, I’d like to see an optional Medicare dental rider that could be purchased. Another possibility could be a one-time benefit for extractions and dentures with a replacement set every 10 years.
Our Solution
A very good solution in my opinion would be allowing all Americans, not just those who have a Qualified High Deductible Health Plan (QHDHP), which I wrote about in last week’s column, to set up a Health Savings Account that could be used to pay for dental, vision, and hearing aid expenses when one goes on Medicare. Deposits could be tax deductible like they are now for those with QDHDP’s, which provide an incentive to save.
What about those who can’t afford to put money in one of these savings accounts or pay a couple thousands of dollars for extractions and dentures? That’s a very fair question. As a compassionate society we should want to ensure that all our senior citizens can chew their food without discomfort.
There are actually quite a few operations that provide dental care on what is called a “sliding scale.” Although not located in Allegheny County, Centerville Clinic has offices in several other Southwest PA Counties and provides discounted dental services based on income. I’ve helped clients get extractions as well as a full set of dentures for as little as $210.
What about dental and vision insurance plans on the open market as a solution? We’ve actually just started the process of getting appointed with Dominion Dental, a subsidiary of Capitol Blue Cross, who is offering two dental plans, one as little as $8/month, as well as a vision plan, that offer good value. We will be making these products available in the next week or so.
I also need to mention that in the last couple of years, Medicare Advantage Plan HMO’s and PPO’s have been offering extremely generous comprehensive dental and vision benefits on select plans. If you’re current Advantage Plan is not providing you with coverage for cleanings, X-rays, extractions, periodontal, crowns, root canals, partials, and dentures along with Over-the-Counter allowances, you are not getting the best value in the HMO and PPO market in my professional opinion. My advice to those considering a move from a Supplement to an Advantage Plan so they can receive these services; have that discussion with myself or another agent before making the move. Advantage Plans can be an excellent way for many on Medicare to insure themselves, but are not right for everyone.
New! Life Insurance at The Health Insurance Store
The Health Insurance Store is now offering Life Insurance; a product I’m a firm believer most people need to have. And just like with health and Medicare plans, we are brokers, appointed to provide products from the most reliable and competitive companies on the market. If you’re interested in a policy that covers your “Final Expenses,” one that is designed to protect your spouse, children, or grandchildren, or to investigate Life Insurance as an investment, give us a call.
Thank you!
Please call one of our office locations or email me personally if you have questions regarding this or any other Medicare/ health insurance related topic or to request an appointment for a no cost consultation. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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