An Rx For Rising Drug Prices
Letting Medicare negotiate drug prices with pharmaceutical companies would help offset the costs from the expanded benefits. For the 2019 bill, the Congressional Budget Office estimated that negotiating prices would reduce federal spending by roughly $456 billion over a decade.
Proponents say the change could also help lower prescription drug costs for beneficiaries. “There’s just a really strong appetite among the public for policy-makers to do something about prescription drug prices,” says Juliette Cubanski, deputy director for the Kaiser Family Foundation‘s Medicare policy program.
The current proposal from Democrats would allow Medicare to cap drug costs at 120% of the average price in six countries . But this would only happen if the government and the drug companies failed to agree on a lower price.
The negotiation process would only apply to single-source brand name drugs with no generic competitors or roughly 25 drugs in 2024 and 50 in later years. These would be selected from the 125 medications with the highest net Medicare Part D spending and the 125 with the highest net spending nationally.
Most medications will probably be unaffected, Cubanski says. Medicare doesn’t need to negotiate prices for every single drug because most are already inexpensive. Instead, the legislation is aimed at lowering costs for medications with no generic alternative. “They don’t have competition forces to keep that price in check,” she says.
Some Medicare Advantage Plans May Cover Dental And Vision Care
Many Medicare Advantage plans include routine dental and vision coverage.
Medicare Advantage plans are required by law to provide all of the same basic benefits as Medicare Part A and Part B. Many plans may also offer extra benefits that Original Medicare doesn’t cover, such as dental and vision care.
Medicare Advantage plans that cover dental and vision care may cover services such as:
- Routine eye exams
- An allowance for prescription glasses and contact lenses
- Routine dental exams
- An allowance for dentures
Eyeglasses And Contact Lenses
Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses .
Note: Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim .
All people with Part B are covered. Your costs in Original Medicare are:
- You pay 20% of the Medicare-approved amount for one pair of eyeglasses or one set of contact lenses after each cataract surgery with an intraocular lens.
- Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter who submits the claim .
- You pay any additional costs for upgraded frames.
- You pay 100% for non-covered services, including most eyeglasses or contact lenses. The Part B deductible applies.
Note: Some Medicare Advantage plans offer extra vision benefits. Be sure to contact the plan for more information.
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Traditional Medicare Typically Doesnt Cover Any Dental Services But Some Types Of Medicare Provide Limited Coverage
More than 60 million Americans receive health insurance coverage through Medicare¹. But does Medicare cover dental care? While Medicare pays for a wide variety of health care expenses, typically it does not cover most dental procedures, dental care, or supplies. This means that if youre currently on Medicare, it might be a good idea to purchase dental insurance to help you maintain good oral health while saving on out-of-pocket costs.
What Dental Insurance Is And How It Works
Dental plans generally fall into one of two categories: basic coverage and full coverage. Generally speaking, a basic dental plan covers preventive care such as checkups, cleanings, x-rays and a few basic procedures, like cavity fillings.
Full coverage plans cover much more and often at a lower out-of-pocket cost to you. For example, they may cover a wider range of preventive procedures such as fluoride treatments and sealants and they may cover those treatments in full or with just a small copay. In addition, a good full coverage plan will cover other types of procedures, including:
- Basic restorative care: This includes fillings, extractions, and non-routine X-rays
- Major restorative care: Bridges, crowns, dentures and the like
- Orthodontic treatment: Braces and other types of teeth aligners
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Does Medicare Cover Dental Vision And Hearing
Original Medicare Part A & Part B helps pay for what is defined as, medically necessary care. This means care thats required to diagnose or treat an illness or condition. Dental and vision care are not seen as medically necessary. Thus, Original Medicare doesnt cover dental exams, eye exams, eyeglasses or other related services. However, you have options if you have Medicare and want help with the cost of dental and vision care.
What Are My Options for Dental, Vision, and Hearing Coverage?
Medicare Advantage Insurance Plans
Medicare Advantage Insurance plans offer the same coverage as Original Medicare Part A & Part B, plus more. Many plans include coverage for dental and vision care. Additionally, many plans may also include prescription drug coverage.
Medicare Advantage plans are offered by private insurance companies. Plan coverage and costs may vary from plan to plan, so we recommend you contact your Medicare advocate at Medicare Pathways to compare all of the plans available in your area. Some plans may charge a premium in addition to the Part B premium you pay to Medicare.
Medicare supplement insurance helps pay some costs that Original Medicare doesnt cover. These costs may include deductibles, co-pays and coinsurance for doctor visits, hospitalization or other medical services. Plans are offered by private insurance companies.
So What Exactly Is Covered
If you are enrolled in Original Medicare, then you may find that Medicare Part B will only cover certain types of preventive and diagnostic eye exams provided that you meet certain criteria, such as:
- Glaucoma Tests For those who may be at high risk for glaucoma, Medicare Part B will cover a test for this condition every 12 months. Here, it will be necessary to pay a 20% copay, as well as to ensure that the Medicare Part B annual deductible has been paid.
- Annual Eye Examinations While Original Medicare does not cover regular eye exams, Medicare Part B may provide coverage for a yearly eye exam for diabetic retinopathy for enrollees who have been diagnosed with diabetes. In this case, too, a 20% copayment would be required. The Medicare Part B annual deductible will also apply.
- Macular Degeneration Some Original Medicare enrollees may be covered for services that are related to age-related macular degeneration. This may include treatment with certain types of injected drugs.
In addition, Medicare Part B may also provide coverage for cataract surgery. Here, for instance, Medicare may cover the cost of the artificial lens that is necessary for replacing the lens that is affected by cataracts. In this case, Part B of Medicare may also cover some limited related costs, such as the expenses for glasses and/or other vision correction products that are needed.
So, what can you do if you would like to secure coverage for various dental and vision services through Medicare?
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Are Vision And Dental Services Covered By Medicare
Original Medicare that is, Medicare Parts A and B do not cover routine vision and dental care. It may cover these services if you have an underlying condition or if you require emergency treatment.
Medicare Parts A and B are designed to cover medically necessary care. This does notinclude:
- Dental exams
- Dental plates
- Routine eye exams for glasses or contacts
Now, Medicare Part A does provide some coverage if you need dental work as an inpatient. For example, if you go to the emergency room because you have severe injuries to your mouth, Part A can provide limited coverage. Or, if you need to prepare your jaw for radiation treatment, it may pay for the cost of extracting a tooth.
Likewise, if you have an object lodged in your eye or experience other trauma to the eye, Part A may provide some coverage when you go to the hospital.
Medicare Part B may cover some diagnostic or preventative vision exams, like glaucoma tests, diabetic retinopathy, or macular degeneration . It may also cover cataract surgery. Part B may also cover glasses or lenses after such a procedure, as well as eye prostheses.
Again, the coverage under Medicare Parts A and B are limited and do not typically cover the routine care we all need. Does this mean you have to pay for care out of your own pocket, or worse, sacrifice checkups and treatments because you cannot afford them?
What Other Additional Services Does Medicare Advantage Cover
In addition to routine dental care, a Medicare Advantage plan may cover other services that Original Medicare generally doesnt cover such as:
- Routine vision including eyeglass lenses and frames
- Routine hearing including hearing aids
- Prescription drugs
Still have questions about comparing Medicare Advantage plans? You can call eHealth to speak with a licensed insurance agent. If youd like to explore the various Medicare coverage options in your area, use the Browse Plans button on this page.
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Do Medicare Supplement Plans Cover Dental And Vision Care
Medicare Supplement Insurance, also called Medigap, does not provide coverage for dental or vision care. Instead, these plans provide coverage for some of the out-of-pocket costs associated with Original Medicare such as deductibles, copayments and coinsurance.
Medicare Supplement and Medicare Advantage are not the same thing. Medigap plans may not be used in conjunction with a Medicare Advantage plan.
If you have Original Medicare coverage and receive vision or dental care under one of the specific instances that are covered by Medicare Part A or Part B , your Medigap plan may be able to help pay for some of your Medicare coinsurance costs, depending on which plan you have and the type of treatment you receive.
You can learn more about Medicare Supplement Insurance by reading this helpful guide.
Lack Of Access To Dental Vision And Hearing Benefits Affects Enrollees Health
Untreated oral health problems or hearing or vision loss can pose serious risks for overall health. Absence of routine dental care can delay diagnosis of some serious health conditions such as HIV and certain infections and cancers and thereby lead to complications and more costly treatments later. Untreated cavities and gum disease can result in infections, tooth loss, and chronic pain. Lack of teeth, in turn, makes eating difficult, reduces quality of life in other ways, and often causes poor nutrition and related health problems. Gum disease is associated with increased risk of heart disease and stroke, higher mortality for those with kidney disease, higher risk of cancer, and more difficult diabetes management.
Individuals with a range of chronic conditions are more susceptible to oral disease, which can contribute to complications from these chronic conditions and exacerbate their symptoms, including diabetes and respiratory conditions. Untreated periodontal disease in pregnant people may also affect pregnancy outcomes.
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Dental Coverage Under Medicare: Comparison Table
In summary, here are the types of Medicare, what they cover, and if dental coverage is available:
|Type of Medicare|
Medicare Supplement Insurance
Costs not covered by Original Medicare
Can Medigap Plans Cover Dental Or Vision
Although Medigap plans are sold by private insurance companies, they usually do not cover dental and vision plans for seniors.
Medigap plans can help you cover out-of-pocket medical expenses. For example, Medigap plans can cover things like:
- Part A coinsurance
- Part B coinsurance or copayments
- Blood transfusions
- Part A hospice care coinsurance or copayments
- Skilled nursing facility care coinsurance
- Part A deductibles
- Part B excess charges
- Foreign travel emergencies
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Medicare Part C Coverage
As an alternative to purchasing Part A and Part B, some participants receive Medicare benefits through Part C, which is commonly known as Medicare Advantage. Instead of the federal government providing healthcare coverage, Medicare Advantages benefits are offered through private insurance companies that have been pre-approved by Medicare.
One of the benefits of choosing Medicare Part C is that many of these plans provide Part D coverage as well. This enables participants to have all of their healthcare needs covered under one healthcare plan.
Although each plan provides different coverages, another benefit is that all Part C plans must provide the same coverages offered under Original Medicare parts A and B. However, some will offer additional benefits related to services and supplies not typically covered by Medicare .
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Benefits: Vision Plans For Seniors
- Eye exam
- Discounts on LASIK or PRK Vision Correction
The benefits and premiums of stand-alone plans may vary greatly depending on three factors:
- the insurance company you select
- your location
- your choice of benefit level
If youre interested in finding coverage thats right for your needs, talk to a licensed insurance agent in your area before purchasing a stand-alone dental or vision plan.
Original Medicare Vision Coverage
Original Medicare also covers limited vision care. It does not cover routine eye exams for contact lenses or glasses.
However, Medicare Part B will cover some preventive or diagnostic eye exams, including glaucoma tests, yearly eye exams to test for diabetic retinopathy and eye tests for macular degeneration.
Medicare will typically cover cataract surgery to implant an intraocular lens if its performed with traditional surgical techniques or with lasers.
Following the procedure, Medicare Part B will typically provide some coverage for corrective lenses. The coverage for corrective lenses under these circumstances is limited to one pair of eyeglasses with standard frames or one set of contact lenses.
Medicare also covers eye prostheses for patients with an absence or shrinkage of an eye due to a birth defect, trauma or surgical removal. Coverage includes polishing and replacements every five years.
If you need vision coverage for routine services, you may want enroll in a Medicare Advantage plan that includes that benefit.
Why Get A Vision Care Plan
Whether you have perfect vision or need corrective lenses, preventive eye care is an important part of your overall health. More than 83% of Americans report using digital devices for more than 2 hours per day, and 60% report digital eye strain. For children, poor eyesight can lead to misdiagnosis of learning and psychiatric disorders which can result in behavioral problems.4
75% of us use vision correction so even if you have 20/20 vision now, chances are youll need vision correction at some point in your life. Adults and children alike should have an annual eye exam to test for such things as sharpness of vision, color blindness, how the eyes work together as a unit, the presence of glaucoma, range of peripheral vision, and more. The exam can also provide early detection of serious conditions such as diabetes, glaucoma, and eye disease.
For just a few dollars a month, a vision plan can make annual eye exams far more affordable, while also helping you save on other types of eye care:
Eyewear. Glasses and contact lenses can be expensive but are often at least partially covered by vision insurance. Sometimes, even prescription sunglasses may be covered.
Lens coatings and enhancements. Some vision insurance plans can help with the cost of lens coatings that help decrease scratching, fog and moisture, reflections, and exposure to ultraviolet rays.
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Does Medicare Cover Vision And Dental
Original Medicare does not cover routine dental or vision care. There are certain circumstances under which Original Medicare may provide some coverage for dental or vision care in an emergency setting or as part of surgery preparation.
However, you may be able to receive routine dental and vision coverage by enrolling in a Medicare Advantage plan that includes dental and vision benefits.
Health And Wellness Program Memberships
Another unique benefit that some Medicare Part C plans may offer is membership to gyms and wellness programs.
Among the most popular of these types of fitness programs is SilverSneakers, which is a fitness program catered to older adults.
SilverSneakers has thousands of participating locations across the U.S. and includes access to exercise classes, outdoor activities, recreational sports leagues, yoga, swimming pools and other gym facilities and much more.
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Medicare Already Offers Coverage For Dental Vision And Hearing Its Called Medicare Advantage
It is increasingly clear that Democrats will have to pare back the $3.5 trillion topline reconciliation figure to clear the Senate. Its less clear how much that dollar figure needs to fall, but according to press reports, the battle of priorities has already begun as various constituencies try to keep their pet programs from getting the axe. One point of contention has been whether to prioritize expanding Medicare to cover vision, dental, and hearing services, or extending Medicaid coverage to lower-income Americans residing in red states that havent expanded Medicaid under the Affordable Care Act. But as it happens, Medicare beneficiaries can already receive vision, dental, and hearing coverage through the program if they want it.
If Democrats are really looking for pain-free ways to cut back on their $3.5 trillion spending spree, scraping the dental, vision, and hearing additions to Medicare would be a good place to start, because the benefits are already available through Medicare Advantage. Perhaps advocates for enhanced Medicare coverage should instead focus on bolstering MA, which already provides a range of tailored benefits to the Medicare population.