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Honored Social Butterfly

Medicare - Dental, Vision, Hearing Benefit Question

A Question to those on Medicare -

Congress is contemplating adding some form of Dental, Vision and Hearing coverage to Medicare.

Don't get too excited, the deal is still FAR from done.  They have to figure out some way to pay for it, but even before that - how much it will cost and the cost depends on the scope of the benefit - each of them.

 

My question to you is -

How do you see the scope of such coverage - in other words, what do you think it should cover and at how much of a benefit ?  

Do you think your dentist, your eye specialist, your audiologist would accept a Medicare (payment) assignment?  

 

Would you be willing to pay more in Part B premiums for such coverage?  Or maybe they will make it another "part" altogether - We have Medicare Part A, B, C, D so maybe a Part E - who knows, the bill hasn't been written yet.

 

If this comes about, we will have some measure of how it meets your expectations.  

Thanks to all who give their opinion here.

 

It's Always Something . . . . Roseanna Roseannadanna
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Bronze Conversationalist

@GailL1 politics aside, consider access to care and cost to the beneficiary.

 

Dental providers almost never accept Medicare. Using the Medicare physician finder I plugged in my (large metro) zip code and searched a 15 mile radius. While there were HUNDREDS of physicians that accept Medicare patients there were only FOUR dentists.

 

Better luck with audiologists and optometrists . . . almost 300.

 

However, just because these providers accept Medicare now does not mean they will continue to do so.

 

Medicare does not cover ROUTINE vision and hearing care. If you have a medical problem that requires treatment or a device, currently you can get care from vision & hearing providers. Patients that are using Medicare benefits make up a very small percentage of the patient population.

 

But if Medicare starts to cover ROUTINE vision & hearing care, the cash flow dynamics of patient care can shift due to lower reimbursement + additional paper work.

 

I would anticipate many of these providers would drop Medicare participation and focus more on cash patients. If this happens, and I see no reason why it wouldn't, the Medicare beneficiary has a benefit they can't use.

 

MAPD plans that have dental, vision & hearing are MANAGED CARE plans. Their policyholder can generally only use those benefits with PARTICIPATING providers. Access to care is limited and the same would be true if DVH were included in original Medicare.

 

 


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Honored Social Butterfly

Couldn't agree more -

But it just seems that this place is not one where any sort of conversation like this really takes off.  It is not a Game, nor a Reward, nor is it Rock n Roll or a subject for the Front Porch in the AARP sense of this board.

I am very discouraged here!!!

It's Always Something . . . . Roseanna Roseannadanna
Bronze Conversationalist

@GailL1IMO this is being oversold just like Obamacare.

My opinion is talk about DVH is another campaign promise for 2022 and possibly 2024.

Looking back . . .

A House bill introduced last week by Rep. Lloyd Doggett, D-Texas, would include things such as dentures, preventive and emergency dental care, refractive eye exams and eyeglasses, and hearing aids and exams.

The expanded coverage also was included in a broader health-care-related bill that cleared the House in 2019 but was not taken up by the Senate. Under that proposal, beneficiaries would have chipped in the standard 20% for some dental coverage. Major treatments — i.e., bridges, crowns, root canals — would have cost more. Dentures also would have been covered, within limits. And routine eye and hearing exams, as well as hearing aids, contact lenses and eyeglasses, also would have been included.


https://www.cnbc.com/2021/07/14/med...al-vision-hearing-under-democrats-budget.html

Many will hear the sales pitch and think "Oh boy, free dental, vision & hearing".

Those same folks, IF it comes about will most likely be very disappointed, just like Part D that roughly 15 years later it is misunderstood by most beneficiaries (and quite a few agents). A high percentage of INFORMED beneficiaries have no clue how to use their plan and end up overpaying both premium and copay.

The few who DO understand Part D rarely use it.

I think DVH will suffer the same fate.

Several folks ASK about SilverSneakers but UHC decided to drop the program because “over 90 percent of policyholders who are eligible for SilverSneakers® “never step foot in a gym.”

I see no reason to believe a DVH plan will be any different. The final result will most likely bear no resemblance to the sales pitch and will be a source of complaint more than praise.

 

MOST medical providers participate in ORIGINAL Medicare but the drop off is significant for MAPD plans.

 

About half the providers (exclusive of hospitals) do not participate in any MAPD plans. Others will accept carrier A and B but not C & D.

 

Roughly 80% of dental providers do not participate in dental insurance or discount plans. Similar results for opticians.


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Honored Social Butterfly

The answer is simple. Medicare for all which includes dental, hearing, eyes. Let the experts design the entire plan so it covers everything then work out how the costs are covered. We did it for the virus and got a vac in months not years, and saved on the total we would have spent with out this approach. It is just like we learned how to best stimulate the economy give money to middle class on down.

Honored Social Butterfly

So let me get your reply straight - @john258 

 

You are saying that Medicare for the current group of beneficiaries should not cover any dental, hearing or vision benefits until Medicare, in some form, covers everybody in the country?

  

Could it be that you think that is the only way that a wide selection of dentist, ophthalmologist, optometrist, audiologist - would accept (just) Medicare coverage?  You might be right about that - if we give them NO option because it is the only plan available (i.e. Medicare-for-all) then they would have no choice except to provide the service and accept whatever bread crumbs in payment government decides to give them.  

 

The questions which I presented in the original post on this thread was to ask people here their personal opinion - nothing more. 

 

Last I looked - Medicare as it is designed today covers many people of ALL incomes - up and down.  All of them get the same benefits - nothing more; nothing less.

 

 

It's Always Something . . . . Roseanna Roseannadanna
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Honored Social Butterfly

Sorry your 1st para is not from me. I said it would include those benefits in Medicare for all, and that should be the next move. The providers will accept a National plan or they have few if any customers. Only in the fantasy world would what they get be bread crumbs. Yes that is what you asked, and I responded since  most know little about this subject a good answer will not be had so you let the experts handle the planing. Your last look was a good one and it would hold under the new program, only there would be more benefits that would cover the entire health spectrum. 

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Honored Social Butterfly

@john258 

The bill that is currently in the works is NOT for Medicare-for-all - it is to add dental, vision, hearing benefits to the current Medicare program.

 

My question is what do seniors (Medicare beneficiaries) want to see covered in this type of benefit for dental, vision, & hearing?  A more extensive coverage plan?  Cost sharing?

Would they pay more for the coverage if it covered more -?

Do they think that their current providers of such services - dental, hearing & vision would participate in such a plan?

 

I am just asking what scope of benefits they are looking for here - then we can compare it to what they MIGHT actually get - if anything; it may all just be left on the doorstep by Congress - no sure thing here at all.

 

It's Always Something . . . . Roseanna Roseannadanna
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Honored Social Butterfly

The current bill is a stepping stone to medicare for all, and when viewed that way you do not spend a lot of time with it. The experts came up with the bill and felt it was a starting point. As I have said before the average person has no idea on how this all works and that is why  we have the experts creating theses programs. Lets all let the experts do their work and speak after they are in place as that way we save time and money.

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Honored Social Butterfly

@john258 

So this isn't important?

You do know it is within the "social" 3.5 TRILLION dollar infrastructure bill -  the one that is suppose to be passed by the Reconciliation process.

CNBC 07/14/2021 - Democrats’ $3.5 trillion budget package funds family programs, clean energy and Me... 

 

WASHINGTON — Senate Democrats released the framework Wednesday for their $3.5 trillion budget resolution bill, which they hope to pass later this summer on a party-line vote.

 

The bill will contain nearly all of President Joe Biden’s American Families Plan bill, plus the addition of expanded Medicare coverage for hearing, vision and dental care.

 

. . . . The chairman of this committee is Sen. Bernie Sanders, I-Vt., who proposed his own $6 trillion budget resolution plan earlier this summer.

But Sanders’ $6 trillion plan was far too costly for centrist Democrats to support, and the current $3.5 trillion bill represents an effort to bridge these internal divisions.

 

The budget resolution also contains a key provision that Sanders has long championed but which was not included in Biden’s original American Families Plan: full Medicare coverage for vision, dental and hearing care.

 

Maybe it will get tossed - so much for some good, thinking conversation !!!

It's Always Something . . . . Roseanna Roseannadanna
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MFA (Medicare For All) is a socialist pipe dream and is NOT the answer to "saving" Medicare.

 

Insurance is a risk management tool. A product designed for the purpose of covering large, unexpected claims, that could potentially bankrupt the average person.

 

Dental and vision routine care is something that can and should be budgeted for in the same manner as tires, brakes and oil changes are for automobiles

 

While it is possible to bake those preventive maintenance  items into an automobile policy it has not been done because it would make car insurance unaffordable for most folks.

 

Routine dental care is $150 - $200 per year for 2x cleaning and exam.

 

Crowns are $1500 or 2x that to include a root canal. Expensive, yes, but many dental practices have bank financing programs that allow patients to pay off a $2000+ bill over 18 months of so.

 

Dental insurance premiums often run $50/month or more, have a 6 to 12 month waiting period for major care, an annual limit of $1000 and 50% of UCR.

 

That $1500 root canal might have to wait 6 months and, if you can wait that long, MIGHT reimburse $600 for a $1500 dentist bill.

 

Did I mention you need to find a par dentist who accepts your plan?

 

Good luck with that. Roughly 80% of dental providers do not participate in ANY dental network.

 

Medicare for all, including dental, is something that, if it ever comes about, will be a disappointment for most like the folks who STILL complain that Obamacare did not include a public option.

 

If you want dental and other add-on benefits in your Medicare coverage, buy an Advantage plan.

 

These are the 7 most common reasons we’ve documented that make people feel Medicare Advantage plans are terrible:

  1. Free plans are not really free
  2. Hospitalization costs more, not less
  3. They make you pay multiple copays for the same issue
  4. You are more likely to see a nurse practitioner than a doctor
  5. They make you get a referral
  6. Plan benefits, costs, and providers change every year
  7. High maximum out-of-pocket limits

https://medicarewire.com/blog/why-medicare-advantage-plans-are-bad/

 

If someone is waiting on the government to "fix" things they will be waiting a long time and be very disappointed.

 

How many folks wanted a Medicare drug plan? 

 

We finally got it in 2006 and what happened?

 

Hardly anyone understood it or likes it. Drug prices and copay's have skyrocketed since then, including generic drugs. And PAC's are rarely available now because of PDP.

 

Too many folks hear "more free stuff" and fail to comprehend the fact that the government creates nothing and rarely fixes anything.

 


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Honored Social Butterfly

We already have a form  of Medicare for all, and have had it for years. Just go to the ER and you will be treated so it is not a socialist pipe dream. We need to improve what we have. We see during the virus the first thing all sides did was make sure all could get treatment at little or no cost. Fact is they are paying people to get their shots as that is cheaper than letting them get the virus.

The die is cast and we move to improve our medicare for all approach which is really not Insurance but something that must be included in all of our way of life. Just look at what the people who will not get their vac are doing to the rest of the country. We see them recant in the hospital after they have the virus, as they now want their vac. True Insurance in medical is over for good, as if all do not have good medical care society does not survive.

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Honored Social Butterfly

Why do you think it is not important? I think it is, and onward to Medicare for all. We can talk about it when we have it so until then watch what the experts are doing to get us there.

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