Vision, Dental and Hearing with Medicare in New York: What Original Medicare Skips and Who Fills the Gap

Original Medicare vs Medicare Advantage vs Medicaid: who pays for what

The table is the whole decision in miniature. Original Medicare is medical coverage for the eyes and ears, not routine care; the routine part comes from an Advantage plan’s extras, from Medicaid, or from your own pocket.

What Original Medicare covers for your eyes

Medicare.gov is direct: Medicare does not cover routine eye exams, sometimes called refractions, for eyeglasses or contact lenses, and you pay the full cost. Eyeglasses and contacts are not covered either, with one exception.

After cataract surgery. Part B covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each covered cataract surgery with an intraocular lens. You pay 20% of the Medicare-approved amount after the Part B deductible, plus any extra for upgraded frames, and the supplier must participate in Medicare.

Glaucoma screening. Once every 12 months for people at high risk: people with diabetes, a family history of glaucoma, African Americans 50 and older, and Hispanic Americans 65 and older. You pay 20% after the deductible.

Diabetic eye exam. Once a year for people with diabetes, by an eye doctor licensed to do the test, at 20% after the deductible.

Treatment of eye disease, such as macular degeneration or an eye injury, goes through the regular Part B medical benefit. The 2026 Part B deductible is $283. Part B premium and deductible.

What Original Medicare covers for dental care

Medicare generally does not pay for routine dental care. Medicare.gov names cleanings, fillings, tooth extractions, dentures and implants as not covered.

There are narrow exceptions, all tied to a medical treatment that needs the dental work to succeed:

• oral exams and dental treatment before a heart valve replacement or certain organ transplants;
• treating a mouth infection, for example by extracting a tooth, before cancer treatment such as chemotherapy;
• treating complications during head and neck cancer treatment;
• dental or oral exams, and treatment of oral infections, before and during dialysis for end-stage kidney disease;
• some dental services during a hospital stay, because of an underlying condition or the severity of the procedure.

Under Part B you generally pay 20% after the deductible for these. Ask the medical team, not the dentist, to document why the dental work is needed for the main treatment, because that link is what makes it a Medicare service.

What Original Medicare covers for hearing

Part B covers diagnostic hearing and balance exams when your doctor or another provider orders them to decide whether you need medical treatment. You can see an audiologist once every 12 months without an order for non-acute hearing problems, such as hearing loss that developed gradually over years, or for services related to surgically implanted hearing devices. The cost is 20% after the Part B deductible, plus a copayment in a hospital outpatient setting.

Original Medicare does not cover hearing aids or exams for fitting them. Because providers know this, Medicare’s appeals booklet notes they do not even have to give you an Advance Beneficiary Notice before selling you a hearing aid: you are expected to pay. What the ABN means.

If the cost of hearing aids is the problem, that is a reason to look at the other two columns of the table above: an Advantage plan’s hearing benefit or, at lower incomes, Medicaid.

Medicare Advantage extras: how to read them before you switch

Medicare.gov’s comparison of the two routes says Advantage plans may offer extra benefits that Original Medicare does not cover, such as some vision, hearing and dental services. The word “some” is the part the advertisements skip: each plan sets its own limits.

Two more rules from experience. Extras change every year with the annual notice of change, so a benefit that drew you in can shrink for 2027. And extras are a poor reason to leave a doctor or hospital you rely on: the medical network is the part of the plan you cannot replace with a discount card. Advantage vs Original Medicare · Advantage plans in NYC by borough.

Sentence for the plan’s member services: “For 2027, what is the annual dental maximum, which dental and vision networks do I use, and how much does the plan pay toward hearing aids?”

If you have Medicare and full Medicaid: the dental, vision and hearing rules

People with both Medicare and full Medicaid get Medicaid’s benefits for the services Medicare skips. Medicare pays first where it covers something; Medicaid covers what Medicare does not.

Dental. The state Health Department lists medically necessary oral exams, cleanings, X-rays, restorations, dentures, extractions, crowns and root canals, and implants in certain circumstances. Since January 31, 2024, replacement dentures and implants no longer need a letter from your physician. Medicaid dental in New York · Finding a dentist who takes Medicaid.

Vision. Medicaid’s usual frequency is one eye exam and one pair of glasses in 24 months, with more when medically necessary, for example when your prescription changes. After cataract surgery, Medicaid’s vision rules treat Medicare Part B as the primary payer for the first pair. Medicaid glasses and eye exams.

Hearing. The 2026 Medicaid hearing aid manual covers hearing aids when medically necessary, based on an audiologist’s or ear doctor’s testing, with prior approval. Audiology testing needs a referral from a physician, physician assistant or nurse practitioner, and a replacement is possible when an aid is lost, stolen, damaged outside warranty or no longer helps.

Which route fits your situation

Free, objective help comparing the extras across plans: HIICAP counseling in New York City. The change has to reach the plan by December 7 for a January 1 start. Medicare enrollment periods.