Key Takeaways
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Medicare still does not cover routine dental and vision care, and this continues to catch clients off guard—even in 2025.
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As an agent, you must be the one to proactively raise this issue early, helping clients explore standalone options or coordinated coverage without overwhelming them.
The Gap That Still Catches Clients Off Guard
Despite years of updates to the Medicare system, some of the most essential everyday health services—dental and vision—are still not covered under Original Medicare. In 2025, this remains one of the most frustrating gaps clients discover after they need the care.
And that delayed realization? It’s where your role becomes more important than ever. Clients need clear, early conversations about what Medicare doesn’t cover just as much as they need clarity on what it does.
What Medicare Covers—and What It Doesn’t
Original Medicare includes:
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Part A (Hospital Insurance): inpatient care, skilled nursing, hospice, and limited home health care.
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Part B (Medical Insurance): doctor visits, outpatient care, preventive services, durable medical equipment.
But here’s what it does not cover:
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Routine dental exams
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Fillings and extractions
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Dentures and implants
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Eye exams for glasses or contacts
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Most vision correction procedures
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Hearing aids (still limited)
There are exceptions for medically necessary services—for example, jaw surgery after trauma or an eye exam related to diabetes—but these are narrow and not substitutes for comprehensive dental or vision care.
Why Clients Don’t See It Coming
Even in 2025, most Medicare beneficiaries assume that routine dental and vision are part of the package. This assumption often comes from decades of employer-sponsored health coverage that bundled these services in.
Retirement brings a psychological shift—clients think Medicare becomes their new workplace health plan. They expect the same features, but Medicare doesn’t fill all the same shoes. And they don’t find this out until they go to schedule a dentist appointment or eye exam.
Your clients aren’t being careless. The system just never highlighted this exclusion clearly enough. That’s where you come in.
Your Role: Set the Record Straight—Early
As a licensed agent working with Medicare clients, your success depends not just on what you sell but on what you explain. Here’s what your conversation should include during initial consultations:
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“Medicare doesn’t cover routine dental or vision. Have you made any plans for that coverage yet?”
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“Are you currently seeing a dentist or optometrist? Let’s talk about what your needs might look like going forward.”
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“Did you have dental or vision coverage under your former employer? Let’s make sure you’re not left unprotected.”
When you bring it up early, you prevent resentment later. And you position yourself as a trusted advisor rather than just a product presenter.
Why This Matters More in 2025
Over the last several years, inflation has pushed healthcare-related costs higher across the board. In 2025, dental cleanings, crowns, and vision prescriptions cost more than they did even two years ago. Even the most basic dental cleaning averages more than $100 per visit, and comprehensive procedures like implants or root canals can run into the thousands.
For vision, a single eye exam can cost over $150 without insurance, and glasses often add several hundred more. On fixed incomes, these are not incidental costs—they’re decisions that get postponed or skipped entirely.
Medicare enrollees who delay care because they didn’t plan ahead often end up with worse outcomes—and higher costs. You can help prevent that.
Understanding the Options Without Overwhelming Clients
Many clients shut down when presented with a flood of choices. You don’t need to go into a menu of every possible standalone plan available. Instead, frame your guidance around:
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Awareness: Let clients know Medicare leaves out dental and vision.
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Assessment: Ask about their current and likely future needs.
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Options: Outline that supplemental coverage may be available, either through private standalone policies or other integrated alternatives. You don’t have to mention specific carriers—just the concept.
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Relevance: Reinforce how often they see dentists or optometrists, and what going without coverage would mean.
Keep it conversational, not transactional.
What About Medicare Advantage?
Many clients ask you whether Medicare Advantage plans fill these gaps—and the answer is, sometimes. In 2025, some Medicare Advantage plans offer routine dental and vision coverage, but the benefits vary widely.
Clients need to know:
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Some plans may cover cleanings but not major dental work
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Vision benefits may include an annual exam and limited eyewear reimbursement
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Coverage is not standardized across all plans
Your job is to help clients compare—not assume—that these plans solve everything. And be clear that Advantage plans are not the only solution, especially for those who prefer to remain on Original Medicare.
What Standalone Plans Usually Cover
Although you can’t recommend specific products, you can walk clients through what a typical standalone dental or vision plan tends to include:
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Dental: Cleanings, x-rays, fillings, extractions, and sometimes root canals or dentures (often with waiting periods or limits).
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Vision: Annual exams, glasses or contacts, and lens enhancements like anti-glare or bifocals.
Coverage levels, deductibles, and provider networks all vary. But knowing there is a solution gives your clients peace of mind.
Questions You Should Be Asking in 2025
To elevate your service and anticipate client needs, make sure you’re integrating these into your Medicare planning sessions:
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“Have you had any major dental work in the last five years?”
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“Do you wear glasses or contacts? How often do you replace them?”
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“Have you been told you need a procedure but delayed it because of cost?”
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“Would you feel more comfortable budgeting for these needs with dedicated coverage in place?”
These questions invite the client to reflect—and engage. They’re not just about compliance; they’re about care.
Anticipating Resistance—And Answering It Gracefully
Some clients will push back:
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“I haven’t needed dental insurance so far.”
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“I’ll just pay out of pocket if something comes up.”
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“Vision isn’t a big deal for me.”
Rather than pushing back with fear tactics, consider gentle nudges:
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“That’s great—you’ve been fortunate. But as we age, our risk for gum disease and tooth loss increases.”
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“Unexpected costs in retirement can feel different than they did while working. Let’s at least have a backup plan.”
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“Vision changes are common in our 60s and 70s. Coverage now might help you act sooner when something shifts.”
Empathy builds trust.
Clients Expect You to Bring It Up
In 2025, the role of a licensed agent isn’t just about enrollment help. It’s about becoming a consistent point of contact for the full health picture.
When you fail to mention dental and vision coverage, clients notice—and they don’t always give second chances. Even if they don’t act on your advice right away, they’ll remember that you brought it up. And they’ll come back when it’s time to act.
By contrast, if you ignore this conversation altogether, they may blame you when bills arrive. Or worse—they’ll blame Medicare. And both hurt your credibility.
What You Say Now Shapes Future Loyalty
Every year, Medicare changes bring new client confusion—and new opportunities to be a better resource. Don’t let dental and vision fall off your radar just because they aren’t part of the core Parts A and B conversation.
Your clients will thank you for going beyond the basics. And when they’re comparing agents, they’ll remember the one who saw the bigger picture.
Expand Your Medicare Support With the Right Tools
Helping clients understand Medicare gaps like dental and vision isn’t just good service—it’s good business. It deepens trust, builds loyalty, and encourages longer-term relationships.
If you want to stay ahead, sign up with BedrockMD. Our platform equips independent agents like you with the resources, training, and automation tools needed to guide clients through every part of the Medicare conversation—not just the sign-up phase.
From lead generation to customized quoting software, we make it easier for you to be the agent they remember. Let’s help you deliver more value and keep clients informed—before gaps become regrets.
