When Are Dental, Vision or Hearing Exams Considered Routine?

Understanding Routine Care

It’s time to go to the dentist for your annual checkup. You check your plan, and it says you pay $0 for routine dental care. That’s great news. But when you go to check out after your appointment, you’re told you have a bill. Sound familiar?

Our plans offer benefits for routine dental, vision and hearing care. But to avoid any surprise bills when you go to the doctor, you should understand what counts as routine.

What’s a Routine Dental Exam?

In general, this is when you go to the dentist for a checkup, cleaning and maybe X-rays. You’re not seeing your dentist to treat any problems with your mouth.

Braven Health Medicare Advantage plan members pay $0 for routine dental services when they see an in-network dentist.

Routine services that are covered:

• Three oral health exams per year, which includes:
  • Oral exams from a general dentist
  • Oral exams from a periodontist or prosthodontist that are needed before you get more complex care, like a root canal
• Three cleanings per year
• One fluoride treatment every six months
• One full-mouth X-ray every three years
• Bitewing X-rays every six months
  • An X-ray of a specific area of the mouth

While the services listed below don’t fall under routine dental services, Braven Health members have up to 50% coverage (up to a $1,000 annual limit) for services like:

• Simple and non-surgical tooth extractions
• Amalgam (silver) and composite fillings
• Treatment for disease that affects your gums and the bones supporting the teeth

Ask your doctor to submit a pre-treatment estimate to Braven Health before treatment. This is an estimate provided to you and your dentist on the potential coverage for the services you are needing. You’ll then get a document that shows you the breakdown of your coverage. This is not a guarantee of services.

Please note: Your costs may be higher at an out-of-network dentist. They haven’t agreed to Braven Health’s maximum allowed amount for each service. They may hold patients responsible for any costs above that amount.

What’s a Routine Vision Exam?

You’ll have a series of tests to check your vision and the health of your eyes, and/or update eyeglass or contact lens prescriptions. If any vision exams are for a medical problem, it would then be considered a medical exam, which isn’t routine. But your exam may still be covered under the medical portion of your benefits.

In 2024, Braven Medicare Choice (PPO) and Braven Medicare Freedom (PPO) members get their routine vision services from a Davis Vision network provider or network eyewear retailer. You pay $0 for routine vision services when you see a Davis Vision network provider for:

• Routine eye exam, one per calendar year
• Eyeglass lenses, one pair per calendar year

Braven members also get up to $150 each year to spend on new eyeglass frames or contact lenses.

Note: Braven Health Medicare Group members don't get routine eye benefits from Davis Vision. Take a look at your 2024 Evidence of Coverage for more info about your vision benefits.

Read Vision Benefit Highlights to learn what else Braven Health covers under vision care.

What’s a Routine Hearing Exam?

During this exam, a doctor checks the inside and outside of your ears to make sure there’s nothing affecting your hearing. You’ll take a hearing test, too, while wearing headphones. It’ll tell your doctor how well you hear certain sounds.

Braven Health members pay $0 for routine hearing services when they see a HearUSA network audiologist for:

• One routine hearing exam per year
• One fitting or evaluation for a hearing aid per year

Braven Medicare Choice (PPO) and Braven Medicare Freedom (PPO) also have coverage for prescription hearing aids:

• You pay a single copay - $299, $599 or $1,199 per hearing aid when you get it from a HearUSA network audiologist or hearing aid dispenser. The amount you pay depends on the type of hearing aid you and your audiologist choose.
• Hearing aids from a provider outside of the HearUSA network are never covered.

Braven Medicare Group members have a $1,250 annual allowance to buy prescription hearing aids from either a HearUSA network provider or an out-of-network provider. But Braven Medicare Group members get the most out of their benefit by getting hearing aids from HearUSA network providers.

Hearing aids bought without a prescription (over-the-counter hearing aids) are never covered under the hearing benefit for any Braven Health member.

Please note: Call HearUSA at 1-855-825-4706 (TTY 711), weekdays, 8 a.m. to 8 p.m., ET, for help finding in-network hearing providers, arranging your hearing exam and accessing hearing aids.

Know Your Health Plan

Check your benefits before seeing a doctor or specialist. It’s important to know what’s covered and what your out-of-pocket costs may be.

Contact Us

If you have questions or need to find a doctor near you, a Care Manager can help. Call 1-888-621-5894 (TTY 711), option 2, weekdays, from 8 a.m. to 5 p.m., ET.

The information given above is not a complete list of benefits. Check your Evidence of Coverage for more information.