Dental insurance works much in the same way medical insurance works. For a specific monthly rate, or “premium,” your clients are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your clients’ part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia. Vision insurance is generally a supplemental insurance to other types of medical insurance policies. Vision insurance will help offset the costs of routine checkups as well as help pay for vision corrective wear that may be prescribed by the attending physician. Please note, however, that definitions of certain terms may vary across insurance companies. Hearing insurance will cover a portion of the costs of hearing aids.
Dental, vision, and hearing insurance is designed to pay a portion of the costs associated with dental, vision, or hearing care. There are several different types of individual, family, or group dental insurance plans that are grouped into three primary categories: (1) Indemnity (generally called dental insurance) that allows your clients to see a specialist of their choice who accepts this type of coverage; (2) Preferred Provider Network plans (PPO); and (3) Health Managed Organizations (HMO) in which your clients are either assigned to, or have the ability to select, an in-network dentist and/or in-network dental office and use the dental benefits in that network. Generally these offices have a fee schedule or a list of prices for the dental services or procedures they offer. Insurance companies have similar fee schedules which is generally based on Usual and Customary dental services, an average of fees in your clients’ areas. The fee schedule is commonly used as the transactional instrument between the insurance company, the specialist or their office, and the consumer. Indemnity Insurance Plan—This plan may be helpful when your clients want to stay with their dentist and he/she does not participate in a network. By the very nature of this plan, the insurance company generally pays a percentage of services according to the policy purchased. In addition, your clients will want to review the co-payment requirements, waiting periods, stated deductible, annual limitations, graduated percentage scales based on the type of procedure, and/or length of time they have owned the policy prior to starting your procedure.
Do your client’s family members say they’re hard of hearing, even if they don’t notice it? It may be time to get your client’s hearing checked. Hearing loss can have many causes — an inherited condition, illness, or injury. If your clients are suffering from hearing loss and need a hearing aid, there are certain situations where you may be eligible for coverage under Medicare.
Hearing aids and Original Medicare, Part A and Part B
In general, Original Medicare and most Medicare Supplement (or Medigap) Plans don’t cover hearing aids, routine hearing exams, or fittings for hearing aids. This means that without other insurance, your clients could pay 100% of the cost for routine hearing exams, fittings, and hearing aids. A hearing aid can cost Medicare hundreds to thousands of dollars. Since four out of every 10 Americans who may benefit from a hearing aid are Medicare-eligible, Medicare would have to provide hearing aids for about four million people, making the cost prohibitive for the agency. Medicare Part B does, however, cover diagnostic hearing tests that your clients doctor orders for a medical need like a recent hearing loss due to illness or injury. If your clients doctor orders a diagnostic hearing test, then you would pay 20% of the amount approved by Medicare, plus the Medicare Part B deductible.
- Always make sure your clients doctor accepts Medicare assignment; that is, he or she is participating in the Medicare program. If a non-participating doctor orders a hearing test for them, they might have to pay all the costs of the test.
- Regardless of the outcome of the diagnostic test, Medicare still does not cover the hearing aid itself.
Hearing aids and Medicare Advantage
Some Medicare Advantage plans (Medicare Part C) cover hearing exams and hearing aids. Medicare Advantage plans often offer benefits not typically included with Original Medicare (Part A and Part B), such as routine hearing exams and hearing aids. Since each Medicare Advantage plan is different, your clients should compare plans carefully to find one that fits all of their medical needs. Your clients can see if any Medicare Advantage plans in their area cover hearing aids and exams by using this Medicare Advantage plan comparison tool. If your clients have insurance that covers hearing exams, such as Medicare Advantage or Medicaid, follow your clients plan’s instructions for getting an exam. If their doctor does not perform hearing exams, he or she may refer them to a specialist.
Buying a hearing aid
The cost for hearing aids ranges from hundreds to thousands of dollars. If your clients have health insurance that covers hearing aids, such as Medicare Advantage, be sure to read their plan documents carefully, because they may only be covered if they buy their hearing aid from certain suppliers or through a certain process. If they don’t have such coverage, your clients can buy hearing aids wherever they want. Some states have hearing-related benefits, including coverage for hearing aids, for qualified residents through Medicaid and other state programs. The Hearing Loss Association of America website has state-specific information on hearing aid coverage. Since Original Medicare does not cover hearing aids, your clients should be wary of any ads that say they can get Medicare to pay for their hearing aid. Medicare has neither reviewed nor endorsed this information.
Only a quarter of the 35 million U.S. adults who could benefit from hearing aids actually get them, and one of the main reasons is cost. A hearing aid typically costs a few thousand dollars, sometimes much more, and most insurance plans don’t cover that. Medicare generally doesn’t pay anything, even though hearing loss is a common concern among its beneficiaries. Faced with a hefty expense, many people decide that hearing what’s going on around them is a luxury they can’t afford.
In recent years, however, health-plan coverage has improved somewhat. In a national survey of people who bought hearing aids in 2008, nearly 40 percent said their health insurance paid some portion of the cost, up a few points from four years earlier. (The study was conducted by Knowles Electronics, which makes hearing-aid components.) And a new program by insurer UnitedHealthcare aims to make affordable hearing aids available to not only its own plan members but also the general public. More on that later. Even when it exists, insurance coverage is generally pretty skimpy.
Use the links and contact information below to see if any of these programs can help your clients. Dental
- Some states offer stand-alone dental plans through the health insurance Marketplaces. People with Medicare are not eligible for subsidies to pay for these plans. Find your clients state Marketplace at HealthCare.gov or call the Marketplace call center (available 24/7) at 1-800-318-2596.
- Community Health Centers provide health services, including dental care, to those with limited incomes, usually on a sliding scale payment.
- Local dental schools sometimes provide the community with lower cost services as a way of training new dentists and dental hygienists. Search for a nearby school at the American Dental Association or the American Dental Hygienists Association.
- The Dental Lifeline Network runs a program offering free, comprehensive dental treatment to vulnerable people, including the elderly and those living with disabilities.
- EyeCare America®, a service of the Foundation of the American Academy of Ophthalmology, provides free eye exams and up to one year of care for low-income individuals who qualify.
- Mission Cataract USA offers free cataract surgery to those without insurance (including Medicare/Medicaid).
- Vision USA, a program of the American Optometric Association, provides free eye exams for low-income Americans without insurance.
- Sertoma is a civic service organization that connects people with hearing assistance.
- The Foundation for Sight and Sound, through its Help America Hear Program, provides hearing aids for men, women, and children with limited financial resources.
- The Better Hearing Institute maintains a comprehensive, free Guide to Financial Assistance for Hearing Aids.