As you know (if you read the previous FAQ!!), Original Medicare does not provide routine dental, vision, or hearing benefits. So what do you do if you need those services? You have two options:

Option 1: Consider a Medicare Part C plan in your coverage area, otherwise known as a Medicare Advantage plan; or

Option 2: Purchase a dental, vision and hearing stand-alone plan from a private carrier (sometimes referred to as a “DVH plan”).

Let’s look at each option and then compare them.

THE “ADVANTAGES” OF MEDICARE ADVANTAGE PLANS

Let’s start with a Medicare Advantage Plan (Medicare Part C). An “MA Plan” is an alternate way for Medicare beneficiaries to receive their Medicare Parts A and B services through a private insurance company, as well as other benefits and services — such as routine dental, vision and/or hearing — at little to no extra cost. Let’s look at what you get with Original Medicare versus what you may get with a Medicare Advantage Plan.

ORIGINAL MEDICARE v. MEDICARE ADVANTAGE

COVERS / HELPS PAY FOR / COST	ORIGINAL MEDICARE (PARTS A & B)	MEDICARE ADVANTAGE PLAN (PART C)
Hospital stays & in-patient care	Yes	Yes
Medical care & outpatient services	Yes	Yes
Preventative care & services	Yes	Yes
Lab / diagnostic services	Yes	Yes
Durable medical equipment (e.g., wheelchair)	Yes	Yes
May include prescription drugs (Part D)	No	Yes (if Medicare Advantage Prescription Drug Plan)
May include routine dental, vision and/or hearing services	No	Yes
Has an out-of-pocket maximum	No	Yes
May include telehealth services	No	Yes
May include fitness benefits	No	Yes
Cost	Part A & B premium	Part A & B premium + $0-$50 extra
Administered by . . .	Federal Government	Private Insurance Carriers

MEDICARE ADVANTAGE SEEMS TOO GOOD TO BE TRUE . . . IS IT?

As you can see, for little to no extra monthly premium ($0-$50), Medicare Advantage provides you with many more benefits and services than Original Medicare. And all of those services are provided by private insurance carriers (not the Federal Government) who compete for your business, meaning that you will have several options to choose from, with multiple carriers trying to offer better benefits at a lower price.

You may be thinking that an MA Plan is too good to be true. Additional benefits beyond Original Medicare with little to no extra cost? That’s not possible! It absolutely is possible. However, much like Original Medicare, there are two popular misconceptions about MA Plans that we routinely hear from our clients.

MA Plan Misconception No. 1: All MA Plans offer top-of-the-line dental, vision, hearing, prescription drug coverage, free transportation, etc.

You may have seen commercials where the person tells you to call about a Medicare plan that will give you “all of the benefits you’re entitled to,” including dental, vision, and hearing benefits, prescription drug coverage, free meals delivered to your home, and maybe even money back in your Social Security check. We know beneficiaries believe this to be the case, because we’ve had multiple beneficiaries call and ask to be enrolled in “the plan from the commercial that has everything.” Suffice it to say, those beneficiaries were not happy when we had to tell them that no such Medicare plan exists. Why not?!

The reason is that insurance carriers only have so much money to pay for a particular Medicare plan’s benefits, so they have to allocate the money across each benefits category. And the way in which a carrier allocates the money may be based on a particular market’s needs. For example, if you looked at County “A” in State “B,” one MA Plan may have excellent dental and vision benefits and offer free transportation, but may not be as good when it comes to hearing benefits. But another MA Plan in that same county may have excellent hearing benefits and free transportation, but it’s dental and vision benefits may not be that good.

Thus, before calling a licensed agent to discuss Medicare Advantage options, you should identify the benefits that are most important to you, so that the agent can make sure to look for an MA Plan that is strong in those particular benefits. BUT DO NOT EXPECT TO GET EVERYTHING! You will need to prioritize. Maybe hearing and vision are not a priority right now, but dental and free transportation are very important to you. There will be certain MA Plan options for you. Or maybe dental and transportation are not important to you right now, but hearing and fitness benefits are. If so, there will be other MA Plan options for you.

MA Plan Misconception No. 2: All Doctors Accept MA Plans.

Much like your medical insurance before you turned 65, not every doctor accepts every Medicare Advantage Plan. Thus, if keeping all of your current doctors is important to you, you need to make sure that you choose an MA Plan that is accepted by all of your current doctors. Otherwise, you will need to select new doctors who do accept the particular MA Plan that you want to enroll in. Don’t worry though; a licensed agent can assist you with this process.

THE STAND-ALONE DVH PLAN OPTION

As discussed above, if you only have Original Medicare but need dental, vision or hearing benefits, and/or prescription drug coverage, your first option is to enroll in a Medicare Advantage Plan. Your second option is to purchase a DVH plan from a private carrier, which plan would work with your Original Medicare. Let’s look at how this option compares to Medicare Advantage.

Covers / Helps Pay For / Cost	Original Medicare + Part D + DVH Plan	Medicare Advantage
Dental, Vision & Hearing	Yes	Yes
Allows you to continue seeing current Primary Care Physician & your other doctors	Maybe (depends on DVH plan)	Maybe (depends on MA plan)
Has an out-of-pocket maximum	No	Yes
May include telehealth services	No	Yes
May include fitness benefits	No	Yes
Costs are paid by plan v. reimbursed	Depends on plan	Paid by plan if covered
Cost	Part B monthly premium $144.60 (2020) + $30-$70 per month	Part B monthly premium $144.60 + $0-$50 per month

As you can see, although purchasing a DVH Plan to work with Original Medicare would somewhat even the playing field with an MA Plan in terms of benefits, an MA Plan still offers more benefits for less money.

After comparing the two options, you may be thinking, “Why wouldn’t I go with an MA Plan? What’s the downside? As discussed above in the MA Plan option, not all doctors accept MA Plans. Thus, if you cannot find an MA Plan that all of your doctors will accept, and you want to keep seeing your doctors, the Original Medicare + DVH Plan may be your best option.