What Other Plans Does Medigap Cover?

medicare supplemental

Medicare supplemental insurance plans (also called Medigap) exist to cover what Original Medicare does not. Medigap coverage can help with Original Medicare deductibles, copayments, and coinsurance. Medigap also covers some hospital costs, hospice care, blood, nursing facility care, Part B excess charges, foreign medical emergencies, and preventive care. You should compare all the plans before making a decision. This Medigap comparison should consider all the different services you use and need covered.

Medicare itself covers most medical needs. There are some types of care that are not covered, or are covered only in specific circumstances. Do Medigap plans cover these services that Medicare Part A and B do not cover? How about coverage that helps with vision, hearing and/or dental care? Since these are not covered by Medicare they can hardly be considered “gaps” in Medicare. Or can they?

Dental

It is true that Medicare does not cover routine dental care or dentures. Dental coverage is not part of Medicare. Some Medigap plans, however, may cover dental care. This comes about because Federal Law says that companies can offer coverage that is “new and innovative.” There is no specific description as to what this means and some companies have begun offering insurance that covers medical needs outside what Medicare covers. It isn’t unreasonable to consider this “new and innovative.” Dental care has generally not been covered and companies who offer Medigap made the leap. It is still not common, however.

When calling insurance companies about Medigap plans ask if they offer dental as part of their basic coverage. They are only required to offer the specific coverage mandated by the Federal government as part of the “lettered” Medigap plans. They need not offer additional dental coverage. Don’t expect a large number of companies to offer dental coverage in conjunction with Medigap. In fact, you may need to search extensively to find a plan that offers dental care. Be sure to check the costs against just buying a stand-alone dental plan.

Hearing

There is some hearing coverage offered through Original Medicare. It is, however, fairly scant coverage. Your doctor can order tests for hearing and balance and Medicare will cover the tests, and you are required to pay 20%. Medicare covers 80%. The Part B deductible also applies here. If the tests are done at a hospital or an outpatient facility you will also pay the hospital a copayment. Should the tests show you need a hearing aid, Medicare will not cover hearing aids or any exams for fitting hearing aids. Medicare also does not cover routine hearing exams. Medigap plans do not cover hearing aids although companies who offer Medigap coverage may offer such coverage as “new and innovative.” It doesn’t hurt to ask the companies if they have such coverage but, again, not many companies will offer hearing coverage. If they do, you can expect a cost increase.

Vision

Medicare Part B does have some vision related coverage. For instance, there is limited coverage for eyeglasses. You can get one set of eyeglasses with standard frames or one set of contact lenses after you have cataract surgery. This surgery must be one that implants an intraocular lens. You pay 20% of the Medicare-approved amount, and Medicare pays the remaining 80%. The Plan B deductible also applies here.

Glaucoma tests are also covered by Medicare Plan B. These are covered once every 12 months for those at high risk for the disease. High risk groups include those with diabetes, a family history of glaucoma, African-Americans over 50 years of age, and Hispanics 65 years of age or older. An eye doctor who is legally allowed to conduct tests in your state has to conduct the tests. You pay the doctor 20% of the Medicare-approved amount and Medicare pays the remaining 80%. The Part B deductible applies for the doctor visit. If the tests take place in a hospital, you pay the hospital copayment.

Medigap policies do not normally cover vision related treatment. Though it is possible that some companies offering Medigap plans may offer vision coverage as “new and innovative,” but they are not required to do so. If you find a company that does, be aware that there are no requirements over what that coverage must offer.

In both the hearing and vision cases, the percentages you pay are based on the Medicare-approved amount. If the doctor you go to charges more than the Medicare-approved amount, the amount you are responsible for will increase.

Medicare Advantage plans may also offer coverage for vision, hearing, and dental. They are not required to offer any such coverage. You should consider these services and their cost in comparison to similar Medigap coverage (and other outside coverage) before choosing a plan.

While it is possible that some Medigap companies might offer dental, vision, and/or hearing coverage, most will not. Check with companies you speak to about any additional coverage they have as part of their basic coverage. If you cannot find any companies in your area that offer such coverage in conjunction with Medigap, there may be other insurance options outside Medicare and Medigap