Medigap Plans with Dental and Vision Benefits: What's Available?

If you have a Medigap (Medicare Supplement) plan, you already know it helps cover the out-of-pocket costs that come with Original Medicare, such as copays, coinsurance, and deductibles. What many people do not realize until they need care is that Medigap plans do not include dental, vision, or hearing benefits. This is because Medigap plans are federally standardized and limited to covering gaps in Original Medicare, which itself excludes most dental and vision care.

This article explains why standard Medigap plans do not cover dental and vision, what options exist for adding these benefits, and how to compare the available approaches. Plans and coverage vary by location, so always verify the details of any plan available in your area.

Why Standard Medigap Plans Exclude Dental and Vision

Medigap plans are governed by federal regulations that standardize them into specific plan letters: A, B, C, D, F, G, K, L, M, and N. Each letter offers a defined set of benefits, and those benefits are the same regardless of which insurance company sells the plan. The only differences between companies are the premium price and customer service.

The standardized benefits all relate to gaps in Original Medicare coverage. Since Original Medicare does not cover routine dental exams, cleanings, dentures, routine eye exams, eyeglasses, or contact lenses, Medigap plans do not cover these either. Medigap can only help pay for services that Original Medicare already covers to some degree.

Here is what standard Medigap plans do not cover:

• Routine dental exams, cleanings, fillings, crowns, dentures, or implants
• Routine eye exams for glasses or contact lens prescriptions
• Eyeglasses or contact lenses (except after cataract surgery, which Medicare Part B covers)
• Hearing exams or hearing aids
• Prescription drugs (you need a separate Part D plan)
• Long-term care

Innovative Medigap Plans with Extras

While standard Medigap plans cannot include dental and vision, some states allow insurance companies to offer what are called "innovative" or "new and innovative" Medigap plans. These plans start with one of the standard plan letters and add extra benefits on top, such as dental, vision, hearing, gym memberships, telehealth services, or wellness programs.

Important things to know about innovative Medigap plans:

• State-dependent availability: Not all states allow innovative Medigap plans. Availability depends on your state's insurance regulations. You can check with your State Health Insurance Assistance Program (SHIP) or your state's insurance department.
• Higher premiums: The added benefits come at a higher premium compared to the same standard plan letter from the same insurer without the extras. Evaluate whether the additional premium is worth the dental and vision benefits by comparing it to the cost of separate standalone plans.
• Limited insurer options: Even in states that permit innovative plans, only some insurers offer them. Your choices may be limited, and you should compare the innovative plan to the combined cost of a standard Medigap plan plus standalone dental and vision plans.
• Variable benefit levels: The dental and vision benefits included in innovative plans vary. Some may offer only basic preventive dental coverage, while others may include comprehensive dental with major services. Review the specific coverage details before enrolling.

How to Add Dental and Vision If You Have Medigap

If you have a standard Medigap plan and want dental and vision coverage, the most straightforward approach is to purchase standalone plans. These are private insurance products that are completely separate from Medicare and Medigap. For background on Medicare's dental exclusions, see our article on whether Medicare covers dental services.

Standalone Dental Insurance

Standalone dental insurance plans are available from a wide range of private insurers. You can enroll at any time throughout the year since there is no specific enrollment period. Here is what to expect:

• Monthly premiums: $20 to $60 per month depending on plan type and coverage level
• Plan types: DHMO, PPO, and indemnity plans are available. PPO plans are the most common and offer the most flexibility.
• Coverage tiers: Most plans cover preventive care (cleanings, exams) at 100%, basic services (fillings) at 80%, and major services (crowns, dentures) at 50% after a waiting period.
• Annual maximums: Typically $1,000 to $2,000 per year
• Waiting periods: Preventive services are usually covered immediately. Basic services may have a 3- to 6-month wait, and major services may have a 6- to 12-month wait.

Standalone Vision Insurance

Standalone vision insurance plans are also available year-round from private insurers. These plans cover routine eye care, not medical eye conditions (which are covered by Medicare Part B). Typical standalone vision plan features:

• Monthly premiums: $10 to $25 per month
• Covered services: Annual routine eye exam (copay of $10 to $25), frame allowance of $100 to $250, basic lenses covered in full, and discounts on lens upgrades and contacts
• Frequency: Most plans cover one exam and one pair of glasses or supply of contacts per year

Bundled Dental-Vision Plans

Some insurers offer bundled dental and vision plans that combine both types of coverage in a single package. These bundles may be slightly cheaper than purchasing separate dental and vision plans from different companies. They also simplify billing since you deal with one insurer for both benefits. If you need both dental and vision coverage, a bundled plan is worth comparing to the cost of two individual plans.

Medigap Plus Standalone Plans vs. Medicare Advantage

One of the most common questions from people with Medigap is whether they should switch to Medicare Advantage to get dental and vision benefits. This is a significant decision with implications beyond dental and vision. For a deeper look at Medigap considerations, see our guide on how to choose a Medigap plan.

Here is how the two approaches compare:

Medigap + standalone dental and vision:

• You keep Original Medicare and can see any doctor or specialist that accepts Medicare nationwide, without referrals or network restrictions.
• Medigap covers most or all of your Medicare cost-sharing (copays, coinsurance, deductibles), giving you predictable out-of-pocket costs for medical care.
• You need a separate Part D prescription drug plan.
• Total additional monthly cost for dental and vision: approximately $30 to $85 on top of the Medigap premium.

Medicare Advantage with dental and vision:

• Dental, vision, and often hearing benefits are bundled into the plan, frequently at no additional premium beyond Part B.
• Many plans also include prescription drug coverage (MAPD), eliminating the need for a separate Part D plan.
• You must use the plan's provider network for most services. Seeing out-of-network providers may cost more or not be covered at all.
• Copays and coinsurance for medical services vary by plan, and annual out-of-pocket maximums can reach several thousand dollars.
• Some services may require prior authorization.

A critical consideration is that if you drop your Medigap plan to switch to Medicare Advantage, you may not be able to get the same Medigap plan back later. Outside of your initial Medigap open enrollment period (the 6 months after you turn 65 and enroll in Part B), insurers can deny coverage or charge higher premiums based on your health. This makes the decision to switch a potentially irreversible one.

How to Decide What Works Best for You

There are several factors to weigh when deciding how to handle dental and vision coverage alongside your Medigap plan:

1. Assess your dental and vision needs: If you need only preventive dental care and an annual eye exam, a basic standalone plan or even paying out of pocket may be sufficient. If you anticipate major dental work or need new glasses annually, more comprehensive coverage is worth the premium.
2. Compare total monthly costs: Add up your current Medigap premium, Part B premium, Part D premium, and the cost of standalone dental and vision plans. Compare this total to the cost of a Medicare Advantage plan with built-in dental, vision, and drug coverage. Consider the trade-offs in provider access and cost-sharing.
3. Check for innovative plans in your state: Contact your State Health Insurance Assistance Program (SHIP) to find out if innovative Medigap plans with dental and vision extras are available where you live. If they are, compare the total premium to a standard Medigap plan plus standalone coverage.
4. Value provider freedom: One of the main reasons people choose Medigap over Medicare Advantage is the ability to see any provider that accepts Medicare. If this flexibility is important to you, adding standalone dental and vision plans lets you keep that freedom while still getting coverage for your eyes and teeth.
5. Consider the Medigap return risk: If you leave Medigap for Medicare Advantage, getting back into Medigap later may be difficult or expensive. Do not make this switch solely for dental and vision benefits without considering the long-term implications.

Bundled Options Alongside Medigap

Some insurance companies that sell Medigap plans also offer dental, vision, and hearing packages that you can purchase alongside your Medigap plan. While these are technically separate policies, buying them from the same insurer can simplify your billing and may come with a bundled discount.

When evaluating bundled options, compare:

• The total premium of the bundle versus separate policies from different companies
• The specific dental and vision coverage levels (annual maximums, covered services, networks)
• Whether your preferred dentist and eye care provider are in the plan's network
• Waiting periods for major dental services

The Bottom Line

Standard Medigap Plans A through N do not cover dental, vision, or hearing benefits. This is a deliberate design choice, not an oversight: Medigap plans are standardized to cover only the gaps in Original Medicare, which excludes most dental and vision care.

If you have Medigap and want dental and vision coverage, you have several options. You can purchase standalone dental and vision plans ($30 to $85 per month combined), look for innovative Medigap plans in your state that include these extras, or explore bundled packages from your Medigap insurer. While switching to Medicare Advantage is another option, it comes with trade-offs in provider freedom and the risk of not being able to return to Medigap later.

The best approach depends on your dental and vision needs, your budget, and how much you value the provider flexibility that comes with Original Medicare and Medigap. Take the time to compare all of your options before making a decision.

Plans and coverage vary by location. This article is for educational purposes and does not constitute individual advice. Contact a licensed insurance agent or your State Health Insurance Assistance Program (SHIP) to explore the specific options available to you.