Dental, vision and hearing in retirement

These three areas share a characteristic: costs rise with age, the need is near-universal, and original Medicare provides very limited coverage.

What is and is not covered

Original Medicare generally does not cover routine dental care, routine eye examinations or eyeglasses, or hearing aids and the examinations for fitting them.

There are narrow exceptions — dental work that is an integral part of a covered procedure, eye care related to specific medical conditions, and diagnostic hearing tests ordered for a medical reason.

Cataract surgery is covered, and includes a basic pair of corrective lenses afterwards, which is a specific and useful exception.

Many Medicare Advantage plans include benefits in these areas. The benefits frequently carry annual limits that are modest relative to the cost of significant work, and networks may be restricted.

Dental

The largest of the three in cost terms for most people.

Dental needs generally increase with age — restorations fail, gum disease becomes more common, and extractions and replacements become more likely.

Major work such as implants, crowns and dentures runs to substantial sums that are not covered.

Standalone dental insurance exists and is worth evaluating carefully. Policies commonly have annual maximums that have not risen much in decades, waiting periods for major procedures, and cost sharing that leaves a large share with the patient.

For many people the arithmetic works out close to neutral, which means the decision turns on whether the predictability is worth it.

Alternatives worth knowing about: dental schools, which provide supervised care at reduced cost; community health centres with sliding scales; and discount plans, which are not insurance but negotiate reduced rates.

The strongest cost control is preventive. Regular cleaning and early intervention are considerably cheaper than the alternatives, and this is an area where deferring care reliably costs more later.

Vision

Routine examinations and corrective lenses are generally not covered.

Medical eye conditions are covered — glaucoma screening for those at risk, treatment for macular degeneration, diabetic eye disease.

The practical distinction is between refraction, which is not covered, and medical eye care, which generally is.

Costs for glasses vary enormously between providers for equivalent products, and online options have reduced prices substantially for straightforward prescriptions.

Regular examinations matter beyond vision correction: several conditions with serious consequences are detected during routine eye examinations before symptoms appear.

Hearing

The area with the largest recent change.

Hearing loss is highly prevalent in older adults and substantially under-treated, with the cost of devices being a major barrier.

Regulatory changes have allowed over-the-counter hearing aids for perceived mild to moderate hearing loss, which has increased availability and reduced prices considerably.

These are not appropriate for everyone. More severe loss, asymmetric loss, sudden loss, pain, discharge or dizziness all warrant medical evaluation rather than an over-the-counter device.

The reason to take this seriously extends beyond hearing. Observational research has found associations between untreated hearing loss and cognitive decline, social isolation and falls.

Whether treatment reduces those risks is less clearly established, and a large trial found benefit in a subgroup at higher risk. The association alone is sufficient reason not to leave hearing loss untreated on cost grounds.

Budgeting for it

The practical advice.

These costs are lumpy rather than steady — nothing for several years and then several thousand dollars in one.

Building a specific allowance into a retirement budget, rather than treating each occurrence as an unexpected expense, produces better decisions.

Health savings account funds, where available, cover all three categories and are among the best uses of that money.

And where a Medicare Advantage plan is chosen partly for these benefits, checking the actual annual limits against realistic costs is worth doing before assuming they are covered.

Doing the work before Medicare

A timing point worth acting on.

Employer dental and vision coverage generally ends with employment, and the equivalent is harder and more expensive to obtain afterwards.

Which makes the final year of employment the right time to complete outstanding dental work, update prescriptions and address hearing.

The difference in cost between employer coverage and self-purchased coverage for the same treatment is frequently substantial, and the work is generally needed either way.

General information only, not medical or insurance advice. Coverage rules change annually — consult official Medicare resources and a qualified clinician about your own situation.