Why Medicare Doesn’t Cover What You Might Expect

(Prescription Drugs, Dental, Vision, and Hearing)

Why is Medicare so confusing?

Many people assume Medicare works like traditional health insurance and includes:

  • Prescription drugs

  • Dental

  • Vision

  • Hearing

But that’s not the case.

💊 Prescription Drug Coverage – Part D

Medicare did not include drug coverage at all until 2006, when Part D was introduced.

To have drug coverage, a person needs to enroll in one of the following:

  • A standalone Part D plan

  • A Medicare Advantage plan that includes drug coverage (MAPD)

  • Retiree drug coverage through an employer or union

Important Update for 2025:

Seniors no longer face the “donut hole” (gap in coverage), and their annual prescription drug costs are capped at $2,000.
This is a huge win for clients with expensive medications.

Dental, Vision, and Hearing – Still Not Covered

Original Medicare still does not cover:

  • Routine dental care

  • Eyeglasses or eye exams

  • Hearing aids or hearing exams

If your client wants coverage, they must:

  • Buy standalone dental, vision, or hearing insurance, or

  • Enroll in a Medicare Advantage plan that includes some level of these benefits

Why Dental Is More Than Just Cosmetic

Explain to clients that dental care is not just about clean teeth:

“Your mouth is the gateway to the body. Gum disease and infections can lead to serious health problems like heart disease, stroke, pneumonia, and worsen conditions like diabetes. Routine dental visits can even help detect early signs of chronic illness.”

Most people need dental care, and many don’t realize Medicare doesn’t help until they get a big bill.

What to Ask Clients

If your client chooses a Medicare Supplement (Medigap) plan:

  • Ask: “What are you doing for dental, vision, or hearing coverage?”

  • Most Med Supp clients do not have any coverage for these services and don’t realize they need to add it.

If your client chooses a Medicare Advantage plan:

  • Most come with basic dental (usually 2 cleanings per year)

  • Ask: “Do you have any upcoming dental work or specific dental needs?”

    • If yes, consider adding a standalone dental plan to cover major services like fillings, crowns, or dentures.

Bottom Line

  • Medicare doesn’t automatically include drugs, dental, vision, or hearing.

  • It’s your job as the agent to help clients fill those gaps—before they get hit with high out-of-pocket costs.

  • Take time to ask the right questions, and you’ll build trust and protect your clients more effectively