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Andrew Smith

Andrew Smith

WHAT IS THE MEDICARE COVERAGE FOR EYE CARE AND EYEGLASSES?

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Does Medicare Cover Vision And Glasses?

Regular eye exams and glasses are not covered by Original Medicare, but if you have an eye condition or accident, Part B (medical insurance) may assist in paying for some vision-related services.

The same coverage as Part B is offered, in addition to more, by Medicare Advantage (MA) Plans, an alternative to Original Medicare. For routine eye exams and corrective lenses, the majority of MA plans provide some coverage.

Only the medically necessary therapy for your eye problems is covered by Part B’s vision insurance. Some of the eye disorders covered by Part B could be a typical and expected aspect of growing older and are regarded as Medicare-covered therapies. All Medicare-covered services as well as a few non-covered Medicare services, such as annual eye exams and financial assistance for corrective lenses, are covered by MA plans.

does medicare cover eyeglassesWhat Kind Of Vision Care Is Medicare Covered For?

These medically required vision-related services are covered in part by Medicare Part B:

  • It is unclear whether lasers or conventional surgical methods are used during cataract surgery. During this treatment, a clear artificial lens known as an intraocular lens (meaning “within the eye”) is used to replace your hazy lens, which is the cause of your blurry vision.

  • If you have cataract surgery, you will need corrective lenses, either one pair of glasses with standard frames or one pair of contact lenses from a Medicare-eligible vendor.

  • If you are at risk for glaucoma, which is an increase in eyeball pressure that eventually affects your vision negatively, you should get a glaucoma screening test once every 12 months. Glaucoma risk factors include:

  • You should get an eye exam every year for diabetes-related retinopathy. To form a visual image, the retina and optic nerve interact to cause retinopathy, a disease of the retina. This examination must be performed by a licensed eye doctor in your state. Medications, laser treatments, and surgery are all options for treatment.

  • Part B may cover specific diagnostic tests and treatments for eye disorders and conditions if you suffer from age-related macular degeneration (AMD). Loss of eyesight is caused by deterioration of the macula, a small central region of the retina. Medications, laser treatments, and vision aids are all options for treatment.

Medically essential vision treatment is covered the same way as it is under Part B in Medicare Advantage plans, as well as some coverage for routine eye exams and corrective lenses.

Which Medicare Plans Are Best If You Need Vision Care?

If you require vision treatment, Medicare Advantage plans are preferable. All services covered by Original Medicare Part B, as well as assistance with yearly eye exams and corrective lenses, are also covered by MA plans.

According to the Kaiser Family Foundation, in the United States in 2022, 98 percent of individual Medicare Advantage Plans and 96 percent of Special Needs Plans (SNPs) will provide some vision benefits. In most cases, you must pick in-network medical professionals, and you might also require a referral or advance approval.

The Evidence of Coverage (EOC) or Summary of Benefits paperwork for each plan contains information on the vision care benefits you are eligible for and how much you will be required to pay. Some plans provide additional vision care coverage for an extra cost each month.

Medicare Advantage Plan ProviderAdditional Vision Benefit
AetnaRoutine exams covered; $90 reimbursement allowance for lenses every year.
Blue Cross Blue Shield/AnthemRoutine exams covered; Optional supplemental tiered packages are available for a monthly premium. $100 to $200 allowance for lenses every year.
HumanaRoutine exams covered; $100 allowance for lenses every year.
Kaiser PermanenteRoutine exams covered; $200 allowance for eyewear every year; Optional pkg with higher monthly premium: $400 allowance for eyewear every year.
UnitedHealthcareRoutine exams covered; $200 allowance for lenses (standard eyeglasses OR contacts) every year.

The Medicare website allows you to look for plans. Check with your eye care provider to determine if they are in-network with the plan you choose if you anticipate needing vision care and corrective lenses.

medicare advantage plansHow Much Does Vision Care Cost With Medicare?

The cost of your vision treatment will depend on your needs and the kind of Medicare insurance you have.

Original Medicare covers all costs for eye exams for contact lenses or glasses. Once your yearly Part B deductible ($233 for 2022) has been met, Part B coverage kicks in and you pay 20% of the Medicare-approved price for a doctor’s services if you receive vision care that is medically required. You also make a copayment if the service is provided in an outpatient hospital environment. Your overall out-of-pocket expenses will be determined by:

  • You may also have other insurance.

  • The fee schedule of your physician

  • Regardless of whether your physician accepts Medicare assignments

  • Your test, item, or service’s type and location

To learn more about your out-of-pocket expenses under Original Medicare, speak with your clinician.

The cost of vision care varies according to your MA plan if you have one. All MA plans provide the same medically required benefits that are covered by Medicare under Part B. Even so, you usually have to use in-network doctors and hospitals, and your copay and coinsurance amounts may vary.

Although you still pay your Part B monthly premium of $170.10 for 2022, several MA plans have a $0 monthly premium for vision benefits. Some MA policies provide supplemental vision care coverage for a monthly fee ranging from $10 to $70. The majority of MA plans that offer vision coverage have a budget that you may use to buy contacts or glasses. This amount, which can be used once every 12 or 24 months and ranges from $100 to $200, depends on the plan. You are liable for any additional fees associated with corrective lenses.

Medically essential vision care is regarded as a Medicare-covered benefit regardless of whether you have Original Medicare or an MA plan. You may be required to pay a copay or coinsurance as part of the costs associated with receiving treatments from approved providers.

Routine eye exams and corrective lenses are examples of vision care needs that are not normally covered by Medicare, but MA plans typically include benefits to lower your out-of-pocket costs. It should be noted that your out-of-pocket expenses for these services do not count toward your medical coverage’s maximum out-of-pocket limit.

vision benefitsIs An Ophthalmologist Covered By Medicare?

An ophthalmologist is a specialist in the eye and vision care who diagnoses and treats eye conditions, performs medical and surgical procedures, and recommends and installs corrective lenses. In circumstances of medical and surgical concerns involving the eyes, Medicare will assist in paying for ophthalmologist services. Regular eye exams or corrective lenses, whether they are provided by an ophthalmologist or an optometrist, are not covered by Original Medicare.

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