What the Letter Leaves Out, part five. The extras are the part of a plan people notice first: dental, vision, hearing, sometimes more. They are real, and for some people they matter a great deal. But the letter usually says only that a benefit changed, not what it now covers or how much it pays, and the details that decide whether an extra is worth anything to you are a few documents deep. This week ends where the workshop's checklist ends: with the extras, last on the list, on purpose.
Does Original Medicare cover dental, vision, and hearing?
Mostly not. Medicare's handbook, Medicare & You 2027, says Original Medicare "doesn't cover some services, like routine physical exams, eye exams, and most dental care." Advantage plans "must cover all medically necessary services that Original Medicare covers," and, in the handbook's words, "Plans may also offer some extra benefits that Original Medicare doesn't cover." That word "may" is doing a lot of work. Whether a plan offers an extra, and how much of it, varies from plan to plan.
What does the little tooth on Medicare.gov mean?
Less than you would hope. Plan cards on Medicare.gov carry small icons for extras, and the tooth is the one people ask about. In the plan data we pulled on October 1, the dental flag read "not specified" for every one of the 101 plans in Scottsdale and all 81 in Las Vegas, even for plans whose detail pages list cleanings, X-rays, and crowns. So the icon cannot tell you whether a plan's dental benefit fits your mouth. The detail page gets you closer. The plan's own documents get you the answer.
Where do the real limits live?
In two documents from the plan itself. The Summary of Benefits lists each extra with its copays and, usually, a yearly dollar limit or a visit limit. The Evidence of Coverage is the long version, with the rules: which services count, how often, and whether you must use the plan's own dental, vision, or hearing network, which can be different from its medical network. For most plans we pulled, the Summary of Benefits lives on the company's website rather than on Medicare.gov, so expect to look there.
What questions should I ask about an extra?
Four, for each one you care about. How much will the plan pay in a year, in dollars? How often can I use it, for example how many cleanings or how often new glasses? Do I have to use a specific network of dentists, eye doctors, or hearing providers, and is mine in it? And what do I pay at the visit? A dental benefit with a low yearly limit and a network your dentist is not in is not much of a benefit for you, however large the tooth looks on the screen.
Why are the extras last on the list?
Because the workshop's order is doctors, then hospitals, then prescriptions, then the plan with the most matches, and only then the benefits. A plan with a generous dental allowance is no bargain if your cardiologist is not in its network or your prescriptions cost more there. The extras are the tiebreaker between plans that already pass the first three tests, not the reason to pick a plan that does not. If you missed the rest of the week, part one covered deductibles, part two your worst-case year, part three your drug plan, and part four your doctors.
What a Certified Medicare Planner® does differently
They read the Summary of Benefits and the Evidence of Coverage so you do not have to, and they ask the four questions above for the extras you actually use. Then they put the extras where they belong: after your doctors, your hospital, and your prescriptions are settled. The Annual Enrollment Period runs October 15 to December 7. The advisors are at 602-281-3898.
You Finished the Series
Up next: Both Ends of the Table →A seven-part series on the largest wealth transfer in history — for the families on both sides of it.
Disclaimer: This article is for educational purposes only. It is not sponsored, endorsed, or otherwise representative of Medicare or the federal Medicare program. American Retirement Advisors is not a government agency. For official Medicare information, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).