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medicare vision benefits

Medicare Vision Benefits

Original Medicare doesn’t cover routine eye exams for prescription glasses or contact lenses.  However, it typically includes preventive and diagnostic eye exams under Part B.  The details of what Medicare covers for more comprehensive eye care can vary.

The extent of Medicare’s coverage for vision care and corrective lenses can be limited or nonexistent with few exceptions.  Knowing this helps you make informed decisions about additional vision insurance or alternative options for those services not included in your Medicare plan.

Does Medicare Part B cover vision?

Medicare Part B offers coverage for outpatient medical needs, but it typically EXCLUDES routine vision care.  This means you’re generally required to pay out of pocket for standard eye exams, eyeglasses, or contact lenses.  Nevertheless, Medicare Part B does provide coverage for certain medically necessary vision services.

Examples of Covered Services

  • Diabetic Retinopathy ─ Yearly screenings for those with diabetes.
  • Macular Degeneration ─ Certain diagnostic tests and treatments, including injectable drugs for those with age-related macular degeneration.

Non-Covered Services

  • Routine Eye Exams ─ Eye exams for prescribing glasses or contacts.
  • Eyeglasses and Contacts ─ Corrective lenses are not covered except after cataract surgery that implants an intraocular lens.

Medicare Part B’s coverage is specific to conditions where eye care is a part of the broader medical treatment required for a condition.

To determine your coverage, it’s essential to verify if the services you need fall under the umbrella of medically necessary procedures.  If you have concerns or specific conditions that affect your vision, don’t hesitate to check with Medicare or your healthcare provider.

This coverage is provided under Medicare Part B, which typically requires a deductible and 20% coinsurance for covered services, provided the healthcare provider accepts Medicare.

Original Medicare generally does not cover routine eye exams for glasses or contact lenses.  However, Medicare Part C Advantage plans may offer expanded coverage, including routine vision care.

Always verify your eligibility and the extent of your coverage with your Medicare plan to ensure you understand your eye care benefits.

Medically-Necessary Vision Services Covered by Medicare

Medicare provides coverage for various vision services that are deemed medically necessary.  This means the services are needed to diagnose or treat an illness, condition, disease, or injury affecting your vision.

Does Medicare cover diabetic eye exams?

Frequent eye exams are crucial if you have diabetes.  Medicare Part B covers annual eye examinations to help detect diabetic retinopathy early and prevent the disease’s progression.  You are eligible if you have diabetes.  Usually, you pay 20% of the Medicare-approved amount after the Part B deductible.

Does Medicare cover macular degeneration?

Medicare Part B covers treatment for Age-Related Macular Degeneration (AMD).  For those diagnosed with macular degeneration – a condition that can lead to loss of vision – various treatments are covered under Medicare to manage and slow the disease’s progression.  This includes certain diagnostic tests and treatment procedures, including intravitreal injections, but does not cover routine eye exams for glasses.  Cost-sharing applies after your deductible.

Does Medicare cover eye exams for glaucoma?

Glaucoma screenings are covered by Medicare Part B once every 12 months for individuals at high risk.  This includes people with diabetes, a family history of glaucoma, African Americans aged 50 or older, and Hispanic Americans aged 65 or older.  After meeting the Part B deductible, you’re responsible for 20% of the Medicare-approved amount.

Does Medicare cover cataract surgery?

Medicare Part B generally helps cover the cost of surgery to remove and replace the lens, which includes the cost of standard intraocular lenses implanted during the surgery.

Post-surgery corrective lenses provided by an ophthalmologist (one pair of eyeglasses with standard frames or one set of contact lenses) are also covered.  You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Does Medicare cover eye exams, glasses, and contact lenses ?

As mentioned, Medicare typically does NOT cover routine vision services, including eye exams for prescribing eyewear and the eyewear itself, such as glasses or contact lenses.

Medicare Advantage plans, however, may be an option for you to consider.  Many of these plans offer additional vision benefits, including coverage for routine eye exams and possibly even allowances for glasses or contact lenses.

To ensure you have coverage for vision services, you would need to proactively select a Medicare Advantage plan that includes vision benefits.  Reviewing the specific plan details is essential, as the extent of coverage and out-of-pocket costs can vary between different plans.

Are there ways to supplement Medicare to help cover the cost of eye care?

To address the limitations of Original Medicare in covering vision care, you can purchase additional vision insurance plans.  These plans are designed to extend your vision benefits and provide financial support for various services and items not included in Medicare, such as:

  • Routine Vision Exams ─ These exams are essential for maintaining eye health and typically include a comprehensive assessment of your vision and eye condition.
  • Prescription Eyewear ─ Coverage often extends to corrective devices like eyeglasses and contact lenses, which can be a recurrent expense.

Note: When selecting a plan, confirm that your preferred eye care providers are within the plan’s network to maximize your benefits.

Unless you’re getting routine vision coverage bundled with an Advantage plan, we advocate paying cash for ancillary services, such as vision care for a couple of reasons:

  • Many of the plans we’ve seen are expensive when considering the benefits you might receive. We call this “dollar swapping,” when you pay a dollar in premiums to receive a dollar in benefits. What’s the point?
  • Providers readily offer discounts to cash-pay patients. Doctors, dentists, and optometrists love it when patients are paying cash.  You won’t even need to grovel or jump through hoops for discounts.  Just say the magic words, “I’m paying cash today.”  You may be surprised how much they’ll knock off the bill.

Having said all that, we realize some people still want a vision plan.  For those who have grown accustomed to the sort of group insurance they’ve had with an employer, this is normal and makes you comfortable.  So, let’s explore that route.

When considering vision insurance complementing your Medicare coverage, the simplest solution is often a rider that comes with a standalone dental plan.  At the time of writing this, I can’t say that I’ve seen one I could get excited about, but they’re available.

Beyond that, VSP Vision Care emerges as a significant provider.  It is recognized for its extensive acceptance among eye care professionals and optical retailers.

  • Availability ─ VSP’s plans are readily accessible, being offered as additional benefits to your Medicare plan.
  • Provider Network ─ With VSP, you can access a large network of optometrists and ophthalmologists, along with various optical stores that readily accept VSP insurance.
  • Enhanced Benefits: By opting for VSP, you can enjoy benefits that often extend beyond what Medicare covers, including allowances for eyewear and discounts on services like lens enhancements.

While Medicare provides some vision coverage, a dedicated vision insurance plan like those offered by VSP can offer more services and products.  For the record, we’re not endorsing VSP ─ this is just to say it’s one of a number of options that may be available to you.  Consider your specific needs when selecting a vision insurance provider to ensure comprehensive eye care.

Limited Coverage Under Medicare Advantage Plans

When selecting a Medicare Advantage (Part C) plan, it’s vital to understand the vision coverage provided.  These plans are from private insurers and often offer additional benefits compared to Original Medicare.  However, there are key details and limitations you should be aware of regarding vision benefits.

What’s Typically Covered:

  • Routine eye examinations
  • Partial allowances for corrective eyewear

Key Considerations:

  • Coverage Scope ─ Each plan’s coverage level varies, so it’s imperative to review the specifics.
  • Allowances ─ Not all expenses may be covered ─ you may receive allowances for glasses or contacts that only cover a portion of the cost.
  • Provider Networks ─ Check if your preferred eye care providers are included in the plan’s network.

Paying Cash for Vision Care

As mentioned, when your Medicare plan doesn’t cover certain vision services, you have alternative ways to manage costs effectively.  One approach is to discuss the possibility of cash discounts with your eye care provider.  Many providers offer reduced rates for services paid for out of pocket.

You can also take advantage of certain tax-advantaged accounts.  With a Health Savings Account (HSA) or Flexible Spending Account (FSA), you might be able to pay for eligible vision care expenses with pre-tax dollars.

  • HSA Contributions ─ If you have a high-deductible health plan (HDHP), contribute to an HSA to cover glasses, contacts, and sometimes even LASIK.
  • FSA Options ─ Use your FSA for copayments, deductibles, and other vision-related expenses.  Remember, FSAs have a use-it-or-lose-it policy, so plan accordingly.

Final Thoughts

Understanding your vision coverage under Medicare ensures you make choices that are aligned with your health requirements and budget.

Review Medicare updates periodically, as policies may change.  If you need help, consult with your trusted, independent Medicare broker.

Like any insurance program, Medicare involves complexities regarding coverage options and costs.  I’m here to help you make informed choices that align with your healthcare needs and financial circumstances.

Rodney POWELL

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