Senior Listening

I am now on Medicare what are my options for dental, vision and hearing insurance?

There are a few standalone dental vision and hearing plans, however, before purchasing you should know if they are network plans or indemnity plans.

Let us start with the provider designations and what they mean. A Preferred Provider Organization has a set network of service providers who provide services at a negotiated discounted price. Customers covered by a PPO plan can select their own provider, however, it must be one in the list of preferred providers. Customers usually pay more money to use an out-of-network provider, the copay varies from PPO to PPO so you should research options prior to purchasing coverage.

If you utilize a PPO insurance plan, the provider files the claims with the insurance company. You would pay the provider your copay for the services. Though benefits for PPO insurance plans vary, most cover preventative services and many offer coverage for basic and major services as well.

Indemnity Plans (Fee for Service Plans): Indemnity plans allow customers to receive services from any provider. There is no network requirement. Customers are reimbursed a set amount for each covered service. Each service will have its own preset coverage and anything above that amount is the customer’s responsibility. Indemnity plans usually cost more; however, they can be more flexible in your choice of providers This is a good option for rural areas such as NE Montana where there may be no PPO providers available, or your provider is not part of the PPO.

Generally, the customer must complete and submit a paper claim form to the insurance company and wait to be reimbursed for the services. In many cases you pay more out-of-pocket for premiums and copays for indemnity plans.

Dental Options: Your options vary depending on your location and your provider. In many rural areas there are no PPO dentists, so your options are limited to purchasing an Indemnity plan or traveling to a PPO dentist. Some dentist offices will bill your plan for you, and you either must pay upfront following your appointment or the office may send you a bill after receiving payment or a denial from your insurance. Other offices you will need to obtain the billing information and procedure codes from the dental office and submit it yourself. If you have Medicaid many dental offices do not accept Medicaid so it is important to locate the closest dental office that will accept Medicaid.

Medicare does not cover most dental care such as routine cleaning, fillings, extractions, or dentures. In some cases, Medicare will cover dental services if they are related to a covered service like heart valve replacement, organ transplants or cancer treatments. Its best to ask ahead of time if the service will be billed by your provider and if its covered. If Medicare does not cover a service, your Medicare Supplement will not cover either. Medicare Advantage plans may cover some dental but that varies depending on the plan. Note that to have an Advantage Plan you must be in their service area and your dentist would need to be in their network as well. When in doubt find out before you receive services.

VA coverage for dental, vision and hearing are dependent on your category and classification. Contact your local VA representative for more information: Brenda Evans or Steven Mulonet: Veteran Service Officers 406265-4225.

Seniors who are on the Qualified Medicare Beneficiary program, which is a program that provides state-funded assistance to low-income Medicare enrollees to help cover certain healthcare costs do not receive dental, vision and hearing coverage. It is often a shock to individuals who were on full Medicaid coverage who have received dental and vision coverage to find themselves without that benefit when they turn 65 and no longer qualify for full Medicaid and they go on the QMB program. If they do continue to qualify for full Medicaid, they may continue to receive benefits for those services. When working with Medicaid some services need prior authorization. It is difficult in some areas to find providers who accept Medicaid patients.

Vision Options: Most of the above information is the same for vision options. When visiting with local providers check to see what insurances they will bill and whether you must pay up front. Some providers only bill your insurance as a courtesy. If you are on Medicaid, see if they accept Medicaid. There are stand-alone vision plans and plans that combine both dental and vision coverage. Watch for network plans and if your provider is in network if not what the outof- network coverage covers and what your copays will be. Medicare will pay for Glaucoma screening once every 12 months if you are at risk of diabetes, a family history of glaucoma, are African American and 50 or older or are Hispanic and 65 or older. Part B deductibles and copays apply. Your supplement may help you with the copays. In general Medicare does not pay for eye exams for prescription eyeglasses. Medicare will pay for one pair of eyeglasses with standard frames after each cataract surgery that implants an intraocular lens. Your provider and supplier of the glasses/ contacts must be a Medicare enrolled provider for Medicare to pay.

Hearing Options: Medicare covers some hearing related services but there are limitations. If diagnostic and balance exams are ordered by your health care provider, they may be covered. These exams are limited to once every 12 months for non-acute hearing conditions. Your Medicare supplement may help pay the copays if Medicare covers the service, you may have to the pay the Part B deductible if you have not met it for the year, Medicare does not cover fittings for hearing aids, or the hearing aids themselves. Full Medicaid and VA have options for people if they qualify. Organizations such as the Lions Club International, Starkey Hearing Foundation and the Miracle ear foundation provide hearing aid assistance based on financial need. In some cases, you can do a free hearing test online. You can buy inexpen- sive hearing aids or personal sound appliances that help you get by inexpensively. If you are a veteran check to see if you can obtain PSAPs if you are not ready for hearing aids.

In summary, there are stand-alone dental and vision plans and those that offer coverage for hearing and some plans combine coverage. When purchasing a standalone plan, one must consider if they are PPOs or Indemnity plans. It is always wise to ask your provider what plans they will bill and if they are in network or outof- network. If you are on Medicaid, you need to go to a Medicaid provider. If you are receiving Medicare covered service, make sure your provider is a Medicare Provider.