Protection for Your Wellbeing

A bundled plan can help you get preventive care to keep your teeth, eyes and ears working properly.

In 1965, when Medicare was introduced, the need for routine dental, vision and hearing care was considered outside the scope of the program; Medicare beneficiaries were expected to pay for those services on their own. Today, that’s still mostly true. Though Medicare covers some related surgeries and procedures, it doesn’t pay for routine dental, vision or hearing care.

To address the rising costs of care, insurance companies have developed “bundled” plans, which combine dental, vision and hearing benefits under one plan to help you obtain and pay for care. A bundled plan can substantially reduce the cost of checkups, screenings and other services to keep your teeth, eyes and ears working properly.

Bundled basics: How the plans work

Bundled dental/vision/hearing coverage offers the protection of insurance combined with the savings of a discount plan, making routine care more affordable. While details vary, most have basic provisions:

Guaranteed acceptance: You usually can’t be turned down for bundled coverage if you’re enrolled in Medicare. With some plans, there’s a waiting period of 30 days or more before you can start using your benefits.
Provider networks: As with other health plans, many dental/vision/hearing plans have provider networks. The plans negotiate with providers to charge rates that are generally lower than you’d pay without the plan. If you use an out-of-network provider, you’re likely on your own financially for some or all the cost.
Annual benefit cap: There’s often a limit on the maximum benefit you can receive during the plan year. Once you reach this limit, the plan no longer pays benefits until a new year begins, although you may still qualify for the lower negotiated rate from a network provider.
Defined services: The plan spells out specifically which routine products and services are covered (example: dental X-rays, fillings, crowns, regular cleanings and other common procedures). Many complicated procedures are either covered at a reduced rate or not at all. The same applies to vision and hearing coverage.
Coverage levels: Many plans let you choose from two or three levels of coverage, with different service menus, premiums, copays and coinsurance for each. After you meet the annual deductible (if any), preventive care is often covered at 100%; basic procedures at 80%; and certain major procedures at 50%. Copays and coinsurance may also vary depending on the level of coverage you choose. Some top-level plans may let you use a non-network provider but will pay a lower portion of the cost.
Balance billing: Most plans negotiate specific prices with in-network providers for each covered product or procedure. If your provider charges more, you’ll likely be responsible for the difference.

What bundled plans typically cover

Bundled dental/vision/hearing plans are not standardized, so always check carefully to see exactly which services are covered, at what level and price, before enrolling in any plan. This guide gives you a rough outline for what coverage you can expect from most bundled plans.

Dental: Routine preventive care, often covered at 100%, includes cleanings, X-rays, and regular oral exams once or twice per year. More extensive routine care, often covered at 50%-80%, typically includes extractions, root canals, dentures, crowns, fillings, and treatment for gum disease. (Exception: Medicare may pay for some dental services received while you’re an inpatient at a hospital .)
Vision: Basic preventive vision care is usually covered at 100%, typically including eye exams and screenings. Discounts on prescription glasses or contact lenses may be included, too. If you use contacts, there may be a separate charge for the eye exam. Frames, if covered under a vision plan, usually need to come from a list of approved sources. Plans with more comprehensive coverage may include discounts on special lens coatings, bifocal or progressive lenses, and certain vision correction procedures such as cataract surgery, PRK and LASIK. (Exception: Medicare pays for annual eye exams if you have diabetes. It pays 80% for one pair of prescription glasses if you get certain kinds of cataract surgery.)
Hearing: Most bundled plans will pay part of your cost for hearing exams and tests, and they usually offer discounts on certain kinds of hearing aids. The discounts are for specific hearing-related products and services from the plan’s list of approved vendors. (Exception: Medicare may cover a portion of your cost for hearing exams if ordered by your doctor and under certain conditions.)

Covered doesn’t mean fully paid for

You may still have to pay for part of any service listed as “covered.” The term means the procedure is included among the plan’s list of eligible services but not necessarily at 100%. You may be responsible for cost-sharing (copayments and coinsurance), annual premiums and deductibles, and any balances beyond what the plan pays the provider.

Call Alight for guidance

Bundled dental/vision/hearing coverage can save you more than just money – preventive care can help identify potential problems before they lead to more serious health issues. The knowledgeable licensed Benefits Advisors at Alight Retiree Health Solutions can help you sort through your options and select coverage that works with your financial and medical needs. Call 844-360-4712 to schedule an appointment.