This is the gap that surprises people the most. After decades of employer insurance that included at least some dental and vision coverage, it's genuinely shocking to find out that Original Medicare covers almost none of it. My father found this out when he needed a crown six months after enrolling, and the bill was $1,400 out of pocket.
The good news is there are options -- they just aren't automatic. Here's what Medicare covers, what it doesn't, and what you can actually do about the gaps.
Dental Coverage Under Medicare
Original Medicare (Parts A and B) does not cover routine dental care. This includes cleanings, X-rays, fillings, crowns, root canals, tooth extractions, and dentures. If you need dental work, you are paying out of pocket unless you have supplemental coverage.
There is a limited exception worth knowing: Medicare Part A covers certain dental services that are medically necessary in connection with a hospital admission. For example, if you are admitted for a heart valve procedure and your surgeon requires a dental clearance, some of those costs may be covered. But this is the exception, not the rule.
Dental care is expensive. A single crown can run $1,000 to $1,500. A full set of dentures can easily cost $3,000 to $6,000. For seniors living on fixed incomes, this is a real problem.
Your Options for Dental Coverage
Medicare Advantage: Many Medicare Advantage plans include basic dental coverage. This typically covers preventive care (cleanings and X-rays) at 100% and offers some allowance for basic restorative work. The coverage limits vary -- many plans cap dental benefits at $1,000 to $2,000 per year, which does not go far if you need major work.
Standalone dental insurance: You can buy a separate dental plan independent of Medicare. Premiums typically run $30 to $60 per month. These plans usually have annual maximums of $1,000 to $2,000 and waiting periods before major work is covered.
Dental discount plans: These are not insurance -- you pay a membership fee ($100 to $200 per year) and get discounted rates at participating dentists. They are not a substitute for coverage, but they can meaningfully reduce out-of-pocket costs if you do not qualify for or cannot afford traditional dental insurance.
Dental schools: If you live near a dental school, you can often get quality care at 50% to 70% less than regular dental office rates. The work is done by supervised students. For routine care, this is a legitimate money-saving option.
Vision Coverage Under Medicare
Original Medicare does not cover routine eye exams for glasses or contact lenses, and it does not cover eyeglasses or contacts themselves.
What it does cover: Medicare Part B covers medically necessary eye care for conditions like cataracts, glaucoma, diabetic retinopathy, and macular degeneration. If you have cataract surgery, Medicare covers the procedure and one pair of standard glasses or contact lenses afterward. Glaucoma screenings are covered annually for people at high risk.
So if you just need your vision checked and want a new prescription for glasses, that is not covered. But if you have an eye disease that requires medical management, Medicare steps in.
Your Options for Routine Vision
Medicare Advantage: Most Medicare Advantage plans include a vision benefit that covers one routine exam per year and an annual allowance for frames or contacts -- typically $100 to $200. For basic prescription eyewear, this can be enough.
Standalone vision plans: Standalone vision insurance is inexpensive -- often $15 to $25 per month. It typically covers one annual exam and a fixed allowance for lenses and frames.
Discount retailers: Stores like Costco, Walmart, and Sam's Club offer competitive pricing on exams and eyewear for people paying out of pocket. A comprehensive eye exam might run $75 to $100, and basic glasses can be had for $100 to $150 or less.
Hearing Coverage Under Medicare
Original Medicare does not cover hearing exams for the purpose of fitting hearing aids, and it does not cover hearing aids themselves. This is a significant gap given that hearing loss affects roughly two-thirds of adults over 70.
Hearing aids are expensive. A pair of prescription hearing aids can easily cost $3,000 to $6,000 or more from an audiologist. The devices have become less expensive with over-the-counter options now available (more on that below).
What Medicare Part B does cover: diagnostic hearing and balance exams when ordered by a doctor to diagnose a medical condition. If your doctor orders a hearing test as part of evaluating dizziness or ruling out a medical cause for hearing loss, that test is covered.
Your Options for Hearing Coverage
Medicare Advantage: Some Medicare Advantage plans include a hearing benefit with an annual allowance toward hearing aids or hearing exams. The allowances are often limited ($500 to $2,000 per year), but they can meaningfully reduce cost.
Over-the-counter hearing aids: Since 2022, hearing aids for mild to moderate hearing loss can be sold over the counter without a prescription. Brands like Jabra Enhance, Lexie, and Sony CRE are FDA-approved and cost $1,000 to $1,800 per pair -- a fraction of prescription hearing aid prices. For many people with age-related hearing loss, these work well.
AARP hearing program: AARP has a partnership with UnitedHealth Hearing that offers discounts on hearing aids and exams. If you are an AARP member, it is worth checking what is available.
Bottom Line
Dental, vision, and hearing are the three biggest gaps in Original Medicare. If these are priorities for you, a Medicare Advantage plan that bundles these benefits may make more financial sense than Original Medicare, even accounting for network restrictions. Price out both options in your specific area before you decide.
Sources & References
Ben built this site after spending months trying to find straight answers about Medicare for his own father. He writes to give people the clear, unbiased information he wished he had found the first time. Read his full story.
Disclaimer: The information on this site is for educational purposes only and does not constitute legal, financial, or medical advice. Medicare rules and costs change annually. Always verify current information at Medicare.gov or by calling 1-800-MEDICARE. Consider consulting a licensed insurance professional or your State Health Insurance Assistance Program (SHIP) for personalized guidance.