Written by Ari Parker — Updated: Monday, August 22, 2022
Routine eye exams help ensure you have the proper eyewear and vision care as you age. These checkups can also help eye doctors catch several issues that require medical attention. There is a lot of confusion surrounding what Medicare does and does not cover when it comes to vision care, and we’re happy to help you see things a little more clearly.
Vision coverage is handled differently depending on what type(s) of Medicare you have. First, let’s dive into Original Medicare.
Many people who are interested in learning more about Medicare vision coverage are trying to figure out if Medicare pays for routine eye exams and corrective lenses. Unfortunately, Original Medicare doesn’t cover eye exams for eyeglasses or contact lenses, so you’d need to pay 100% of these costs out of pocket.
There is an exception. Medicare Part B will help pay for corrective lenses (glasses or contact lenses) if you have cataract surgery. This means that, if you’ve met your Part B deductible, you’ll pay only 20% of the Medicare-Approved Amount for corrective lenses after a cataract surgery.
Original Medicare will also cover eye care that’s medically necessary, including:
Eye exams for diabetic retinopathy once a year (for those with diabetes)
Glaucoma tests every 12 months (for patients in a high-risk category)
Macular degeneration tests and treatment (for those with age-related macular degeneration)
Eye issues that require inpatient hospital care
Medicare Supplement plans (aka Medigap plans) only fill the cost gaps in Original Medicare coverage. This means that your Medicare Supplement plan may be able to help you with the 20% out of pocket costs for Medicare-covered services but won’t cover any additional services.
Many Medicare Advantage plans offer additional vision benefits (along with dental and hearing benefits). In fact, this is one of the reasons these plans have become so popular amongst Medicare beneficiaries. Medicare Advantage plans are required to cover at least as much as Original Medicare, and additional coverage and benefits will vary.
It’s always important to check the details of a plan’s vision coverage to be sure you know what services will be covered. No one likes a surprise at the doctor’s office!
It’s important to note that additional vision benefits paired with a Medicare Advantage plan may also come with higher monthly premiums. You should compare the added cost of a Medicare Advantage plan that includes vision coverage with both the cost of paying out of pocket or purchasing a private vision insurance plan.
Everyone’s coverage and needs are unique. If you have questions about your current Medicare vision coverage or how to get the coverage you need, we’re here to help. Chapter Advisors will help you understand all of your options so you can choose the best coverage. Give us a call any time. Our advice is always free.