Medicare's lack of dental, hearing and vision coverage can put seniors in a bind
Editor's Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, "Ask Phil," aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, "Get What's Yours for Medicare," and co-author of "Get What's Yours: The Revised Secrets to Maxing Out Your Social Security." Send your questions to Phil.
Cammy – Washington: Why will Medicare refuse to pay for dental work that is really needed?
Phil Moeller: Medicare has never covered so-called routine dental care, including a lot of care that you and I would consider essential to our health.
It will cover surgical procedures that are considered medically necessary and which usually arise from specific health-related events. For example, if you're in an auto accident and your jaw is broken, Medicare will cover that and probably some rehabilitative dental work as well.
But if you lose your teeth over time and need dentures, Medicare would not cover that. Likewise, it would not cover routine dental care, such as extractions or crowns, even if that care was essential to your health.
As the nation continues to get older, Medicare's lack of coverage for dental, hearing and vision care will become a growing issue.
Gina – Alabama: I'm surrounded by elders and others in dire need of vision, hearing and denture care on a day-to-day basis. It saddens me, because my baby son's uncle is a hearing doctor and lives just down the street. Maybe I'm wrong, but it would be awesome if he and his colleagues could give back at least once a year to the very citizens that helped established their practice in this area. As they know, Social Security and Medicare provide only limited income and no real benefits in these health areas.
With dentures, we still have to pay for denture cream in order to eat and not choke. It's just a shame that we can't get prescriptions for the dentures or cream with regular check-ups. I do not see the rationale here. This is what we need to survive, not something we want, like a toaster oven.
I have poor vision. A lot of times, I wind up "seeing" with my heart. I do not understand Medicare's guidelines for hearing, dental and vision coverage. It makes no sense that we are neglected and deprived from being covered. Meanwhile, they cover so many less pertinent issues. This makes us needy. We need Medicare and Medicaid help as well as doctors that can donate some time and maybe some medical aids for us. Yes, they earned that degree, but we are the patients who have kept them in business.
Just my thoughts from the front line of struggles.
Phil Moeller: I am so sorry to hear about your struggles, which I know are shared by millions of older Americans. I'm sharing what you wrote, because people need to be reminded over and over again that Medicare policies have an enormous impact on the quality of peoples' lives.
Larry: My monthly Social Security benefits are less than my monthly Medicare premiums. My benefits are not paid to me directly, but are applied to my insurance premium. I receive a one-time billing for the yearly difference. I'm told that because I don't receive cash, I cannot be held harmless and am subject to the higher Medicare premiums. For 2017, the monthly premium for me will be $134 instead of $109.
Phil Moeller: The rightly maligned hold harmless rule says that Social Security benefits cannot be cut from one year to the next. People whose Medicare Part B premium is deducted from their Social Security thus cannot be forced to pay a premium that is larger than their annual cost of living increase for Social Security. This has led to people paying different amounts for Part B coverage, which is both confusing and unfair.
I shared your situation with a Social Security spokeswoman. She said she couldn't tell from the amount of information you provided whether the agency's response was correct.
However, her response included the statement that the fact you needed to make payments to Medicare (because your Medicare premiums were greater than your Social Security payments) would not, by itself, trigger your exclusion from being held harmless.
So, I suggest you get in touch with the agency and see if there is another reason they boosted your premium. If they continue to say it's because you are paying Medicare directly, you would need to file an appeal. The agency should tell you how to do this, but let me know if it doesn't and you need further help.
Here is the relevant part of what the spokeswoman said:
I can confirm there are cases where a person's monthly benefit payment is less than the amount of his or her Medicare Part B premium. While this is not one of the requirements that applies to hold harmless, the beneficiary is billed directly for the remaining liability amount. This billing is done once a year. See the information at this link, https://secure.ssa.gov/apps10/poms.nsf/lnx/0601001041.
Bart – Arizona: I read your piece about changes coming to Medigap plans in 2020 and am confused. I think I understand that the reason that these plans (C and F) will no longer be available is the government wants the patient to have some first-dollar "skin" in the game. But will they go away for everyone? Also, what will be the status of the high-deductible "F" plan?
Phil Moeller: First off, these plans are only going away for new enrollees. This also applies to the high-deductible F plan.
Most people with a high-deductible F plan would wind up paying for their Part B deductible before reaching this plan's overall deductible. However, it's theoretically possible to use up the entire deductible for other expenses. Therefore, it still qualifies as a first-dollar plan and would fall within these new prohibitions.
I am hardly the know-it-all expert when it comes to what people might do in the future. My concern over these affected plans — C, F and high-deductible F — is that only existing customers will be able to get them beginning in 2020. As a result, the pool of people in these plans will inevitably grow older and probably sicker. This will force insurers to raise rates, as there won't be younger and healthier people in these plans who can share the risk.
Janet: I want to delay my full retirement benefits when I turn 66 this December. Can I receive my divorced spousal benefits when I turn 66 if his is less than mine and delay taking mine?
Phil Moeller: If you qualify for ex-spousal benefits, then yes, you can do this. Your former husband either needs to have already filed for his own retirement benefits or, if not, he needs to be at least 62 years old and you need to have been divorced for two years.
If these conditions are met, you can file what's called a restricted application at your full retirement age for just your ex-spousal benefit. Because it's a restricted application for just this single benefit, it doesn't really matter how it compares with your own retirement benefit.
Changes made by Congress in late 2015 ended the ability of most people to file restricted applications for benefits, but this right was grandfathered into the new laws for anyone who was at least 62 as of the beginning of 2016.
Carol – California: We are moving across the border into Mexico's Baja California Peninsula, but want to keep our Medicare Advantage program and come back to the U.S. for medical care. Do we need to have a physical U.S. address? If so, will the physical address of our post office box in San Diego work, or will we have to use the address of a family member?
Phil Moeller: I get lots of questions about Medicare from people living or planning to live outside the U.S. Medicare Advantage plans require you to live in the plan's service area. Having a P.O. box or address of a family member is not sufficient. If you filed a claim with your insurer, it would be able to reject coverage should it find out that you were not actually living in the U.S., even if you came back to the country for treatment.
There is always a chance the insurer would not investigate your residency, but it could, and the odds of being on the hook for what could be huge medical bills would certainly give me pause. If I was in your situation and wanted to come back to the U.S. for health care, I'd drop Medicare Advantage and get basic Medicare, possibly with a Medigap plan. Even so, getting prescription drug insurance in the U.S. would face the same residency requirements as Medicare Advantage.
I wrote about this in a recent Ask Phil column.
Patricia: I'm 70 and have lived and worked abroad for 50 years. I have no Social Security, but am still thinking of retiring to Florida or maybe Cape Cod. As a U.S. citizen, I know I am obliged to enroll in Medicare when I return. How does it work? How much time do I have to enroll, what will it cost, and should I take Medigap or Medicare Advantage? I don't know any U.S. doctors or how things work. I'm lost!
Phil Moeller: I sympathize with how daunting this process is for someone in your situation. The best advice I have for someone with such broad questions about Medicare is for you to read a comprehensive guide to Medicare. My book, "Get What's Yours for Medicare," covers everything you've asked about, including how to find doctors.
Here are some links to help you get started:
- Joining a health or drug plan
- Part A & Part B sign up periods
- Retirement Planner: Applying for Medicare Only
- Medigap Policy Search
- Medicare Advantage Plans
- Finding Medicare Drug Plans and Medicare Advantage Plans
The good news, which I learned after receiving your question, is that even though you are 70, you should not face any of Medicare's late-enrollment penalties when you return to the U.S. As you told me in a follow-up note, you have been working and have employer group health insurance. As it turns out, such coverage does not have to have been provided in the U.S. or even from a U.S. employer.
Here is the information I was recently given by a Medicare spokesman with CMS (the Centers for Medicare & Medicaid Services). The initials GHP refer to a group health plan.
A GHP does not have to be in the United States, and the individual (or spouse/family member for disabled) is not required to be working in the United States. CMS considers a person working for a foreign employer who has a plan that meets the definition of a GHP to meet the requirement for GHP coverage. This also applies to individuals working in countries with national health plans. . . . CMS doesn't "approve" coverage from certain countries. The employer coverage offered must meet the criteria for GHP coverage. The policy is outlined publicly here.