Why do I need these plans? Doesn't Medicare cover these benefits?

Original Medicare only covers dental, vision, and hearing when it is related to inpatient or outpatient medical necessity.


DENTAL COVERAGE

Medicare has very limited dental coverage that is only meant to protect your general health in order for another Medicare-covered health service to go smoothly.


It does not cover routine checkups, cleanings, fillings, dentures (full or partial), or most tooth extractions. Medicare Supplements also will not cover these additional benefits.


On the other hand, certain Medicare Advantage plans will sometimes include additional dental benefits as part of their network based plan.


VISION COVERAGE

In most cases, Original Medicare does not include coverage for routine eye exams, eyeglasses, or contact lenses.


Normally Medicare will pay only if following cataract surgery that implants an intraocular lens. Following that specific surgery, Medicare Part B will help pay for corrective lenses, one pair of eyeglasses or one set of contact lenses provided by an ophthalmologist.


However, the drawback is it will only offer this benefit once per lifetime and they only pay for a standard pair of eyeglasses. You would be responsible for the cost of upgraded frames.


Part B also covers a glaucoma screening every 12 months but only for people at high risk for it. This includes those with diabetes, people with a family history of glaucoma, African Americans who are 50 or older, and Hispanic Americans who are 65 or older.


Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defects, trauma or surgical removal. It also covers replacement, typically every five years.


Part B will cover certain diagnostic tests and treatment of diseases and conditions of the eye.


If you are wanting routine eye exams and more than one pair of eyeglasses or contact lenses (or better than the standard frames), then finding a stand-alone plan or one where vision benefits are included will be required.


HEARING BENEFITS

If you only have Original Medicare, it does not cover hearing aids. Part B does cover some hearing tests, such as diagnostic hearing and balance exams. You will have to go through your primary care provider for your initial screenings. Once they recommend that you need additional treatment, your Part B coverage will pay for a portion of the costs.


Ultimately what we have found works best is for our clients to enroll in a stand alone plan that combines the dental, vision and hearing benefits. The monthly premium is low and allows you to have more coverage than what you would normally be provided otherwise with just Original Medicare.

How would I enroll?

Fill out the form and we will be in contact soon or press the "Click to Call" button above.


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Jerry Molina Financial and Insurance Services, LLC
Copyright 2024 -- All Rights Reserved

Phone: (956) 342-9469
Email: info@jerrymolinahealthinsurance.com

General disclaimers

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area.

Please contact Medicare.gov or 1–800–MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week or your local State Health Insurance Program to get information on all of your options.


Agency represents Medicare HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan’s contract renewal.


The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. To learn more about a plan’s nondiscrimination policy, please click any of the Nondiscrimination links above in the Health plan disclaimers section.


This information is not a complete description of benefits. Call 1-956-342-9469 (TTY: 711) for more information.


Medicare beneficiaries may also enroll in the plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.


For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.


Every year, Medicare evaluates plans based on a 5-star rating system.


Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations.

Please call the Plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.


Total annual cost is calculated by adding up the total annual cost of any monthly premiums, applicable plan deductible(s) and estimates for all co-pay and co-insurance amounts that will be due for the medications and health benefits used throughout the year.

Costs for medications and health benefits vary across pharmacies and health systems, so the costs provided are only estimates. Actual costs could vary.


For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227).

TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday.

TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office.


You must have both Part A and B to enroll in a Medicare Advantage plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information.


The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.


To send a complaint to a Medicare Health Plan, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.