Medicare's Basic Vision and Dental Coverage
Original Medicare (Part A and Part B) does not cover routine dental care or routine vision care. This means cleanings, fillings, dentures, eyeglasses, and contact lenses are not paid for by the program. However, there are narrow exceptions: Medicare Part B covers eye exams and glasses or contact lenses only after cataract surgery, and it covers treatment for certain eye diseases like glaucoma and diabetic retinopathy when they require medical intervention rather than routine correction.
Dental work is almost entirely excluded. Medicare will not pay for cleanings, X-rays, extractions, root canals, crowns, or dentures under any circumstance in Original Medicare. The only exception is dental work that becomes necessary as part of a covered hospital procedure — for example, if you need teeth extracted before jaw surgery that Medicare covers.
If you have a Medicare Advantage plan (Part C), coverage varies by plan. Some plans include dental or vision benefits, but most do not, and those that do usually cap the benefit at a low dollar amount per year. You must check your specific plan's coverage document to know what your plan includes.
Key Takeaways
- Original Medicare does not cover routine eye exams, glasses, contacts, or any routine dental care including cleanings and fillings.
- Medicare Part B covers eye exams and corrective lenses only after cataract surgery, and covers treatment for eye diseases like glaucoma when medically necessary.
- Some Medicare Advantage plans include dental or vision benefits, but coverage and dollar limits vary widely by plan.
- Standalone dental and vision insurance plans are available for purchase outside Medicare and can cover routine care that Medicare does not.
- Medicaid may cover dental and vision care if you are may be able to access, depending on your state's program rules.
When Medicare Part B Covers Eye Care
Medicare Part B pays for an eye exam if you have a medical condition that requires it — not a routine vision screening. This includes exams to diagnose or monitor glaucoma, diabetic retinopathy, age-related macular degeneration, or other eye diseases. The exam must be performed by an ophthalmologist or optometrist, and the doctor must document that the exam was medically necessary.
After cataract surgery, Medicare Part B covers one pair of eyeglasses or contact lenses (your choice, not both). This is a one-time benefit per eye per lifetime. The glasses or lenses must be prescribed by the surgeon who performed the cataract surgery, and you must obtain them within a set timeframe after surgery — usually within a few weeks. If you want a second pair or a different frame style, you pay out of pocket.
Routine vision screening — the kind you get to check if you need glasses for reading or distance — is not covered. Neither are bifocals, progressive lenses, or lens coatings beyond the basic single-vision lens. If you need vision correction but have not had cataract surgery, you will need to pay for an eye exam and glasses yourself or purchase separate vision insurance.
Medicare Advantage Plans and Supplemental Coverage
Medicare Advantage plans are required to cover everything Original Medicare covers, but they can add extra benefits. Many plans now include a dental benefit or a vision benefit or both, though the coverage is usually limited. A typical dental benefit might cover one cleaning per year and cap annual spending at $500 to $1,500. A typical vision benefit might cover one eye exam every two years and a small allowance toward glasses or contacts.
To find out whether your Medicare Advantage plan includes dental or vision coverage, check the plan's Summary of Benefits and Coverage document, which your plan mails to you each fall during the Annual Enrollment Period. You can also call the plan's customer service number on your insurance card and ask directly what dental and vision services are included and what you pay out of pocket.
If you have Original Medicare and want dental or vision coverage, you can purchase a standalone dental insurance plan or vision insurance plan. These are sold by private insurers and are not part of Medicare. Costs, coverage limits, and waiting periods vary. Some plans have a waiting period before they cover major work like crowns or root canals, so read the plan details before you purchase.
Medicaid Dental and Vision Coverage
If you are may be able to access for both Medicare and Medicaid (called "dual may be able to access"), your state's Medicaid program may cover dental and vision care that Medicare does not. Medicaid rules vary significantly by state. Some states cover routine dental cleanings and fillings; others cover only emergency dental care. Some states cover routine eye exams and glasses; others do not.
To learn what your state's Medicaid program covers, contact your state Medicaid office directly or visit your state's Medicaid website. You can also call 211 and ask for a referral to your local Medicaid office. If you are not sure whether you are may be able to access for Medicaid, the same resources can help you find out.
What You Pay Out of Pocket for Dental and Vision
If you do not have coverage through a Medicare Advantage plan, standalone insurance, or Medicaid, you will pay the full cost of dental and vision care. Costs vary by provider and location. A routine dental cleaning typically costs $75 to $200. A filling costs $150 to $300. A crown can cost $800 to $1,500 or more. An eye exam costs $100 to $200, and eyeglasses cost $200 to $500 depending on the frame and lenses.
Some dentists and eye doctors offer discounts for patients without insurance, or they participate in discount plans that reduce the cost of care. Ask your provider whether they offer a cash discount or whether they participate in any discount networks. Some community health centers also offer dental and vision care on a sliding fee scale based on income.
How to Find Affordable Dental and Vision Care
If you need dental or vision care and do not have coverage, start by calling your local health department or a community health center to ask about low-cost or sliding-scale clinics. Many areas have dental schools and optometry schools that offer care at reduced cost performed by students under supervision.
You can also search for dentists and eye doctors in your area and call to ask about cash-pay discounts. Some providers will reduce their fee by 10 to 30 percent if you pay at the time of service rather than billing insurance. Ask whether they offer a payment plan if you cannot pay the full amount upfront.
If you are a veteran, the Department of Veterans Affairs may cover dental and vision care. If you are Native American, your tribe's health program may offer these services. If you have limited income, your state may have a program that helps pay for dental or vision care — call 211 to ask.
Frequently Asked Questions
Does Medicare cover glasses or contacts for reading?
No. Medicare Part B covers glasses or contacts only after cataract surgery. If you need vision correction for reading or distance vision and have not had cataract surgery, you must pay out of pocket or purchase separate vision insurance.
Will Medicare pay for a dental cleaning?
No. Original Medicare does not cover any routine dental care, including cleanings, X-rays, or fillings. Some Medicare Advantage plans include a dental benefit that may cover cleanings, but you must check your specific plan's coverage.
What if I need a root canal or extraction?
Medicare does not cover root canals, extractions, or other dental procedures. The only exception is dental work that is part of a covered hospital procedure. If you need dental work, you will need to pay out of pocket, use Medicaid if you are may be able to access, or purchase dental insurance.
Can I get a second pair of glasses after cataract surgery?
No. Medicare Part B covers one pair of eyeglasses or contact lenses per eye per lifetime after cataract surgery. If you want a second pair or a different style, you pay the full cost yourself.
Does my Medicare Advantage plan automatically include dental and vision?
No. Some Medicare Advantage plans include dental or vision benefits, but many do not. You must check your plan's Summary of Benefits and Coverage or call your plan to find out what is included in your specific plan.