July 13th 2022
By Ari Parker
Medicare vision coverage varies, depending on what type of Medicare you have and your individual plan. Learn everything you need to know.
By Ari Parker
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.
How Medicare covers vision care is different depending on what type of coverage you have and what condition you need treatment for. In general, Original Medicare won’t cover routine vision care, but will cover treatment and exams for certain conditions. While many Medicare Advantage plans cover vision services, you should look at the details of each plan to make sure you’re getting the best value from your plan.
We’ll dive into Original Medicare first and explain how Medicare handles vision.
Original Medicare doesn’t cover routine vision services, but may cover eye care for certain conditions like cataract surgery and macular degeneration.
Many Medicare Advantage plans cover routine vision services, but you should compare costs of coverage to make sure that the charges are reasonable.
Medicare Supplement plans don’t include vision coverage in the standard benefits. Some insurance providers offer vision and dental coverage at an additional cost.
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.
However, there is an exception to Medicare coverage in certain situations. 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:
Diabetic eye exams (for diabetic retinopathy) once a year
Glaucoma screenings 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
Cataract surgery
While Medicare does not cover yearly eye exams, your “Welcome to Medicare” preventive visit includes a simple vision test. This visit is completely free if your doctor accepts Medicare.
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. Some Medicare Supplement plans offer vision and dental coverage at an additional cost. But Medicare Supplement plans won’t ever include vision coverage as a standard benefit.
Many Medicare Advantage plans offer extra benefits, including vision, hearing, and dental services. In fact, this is one of the reasons these plans have become so popular amongst Medicare beneficiaries. Medicare Advantage plans are run by private insurance companies and offer an alternative to Original Medicare. These plans are required to cover at least as much as Original Medicare, but the additional coverage and benefits vary with each plan.
Usually, Medicare Advantage plans provide coverage for standard vision services like:
Routine eye exams
Eyeglasses and contact lenses (standard frames and lenses—upgrades are typically an extra charge)
Any services for eye care that Original Medicare covers
Prevent care services
Anything beyond these services may not be covered. These plans usually have a maximum amount they’ll spend on vision care in a year. It’s always important to check the details of a plan’s vision coverage or contact a health care provider to be sure you know what services Medicare will help pay for. 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 at 855-900-2427 or book a time to talk in advance. Our advice is always free.
