Vision insurance coverage is an important necessity for consumers in the United States. According to the National Eye Institute, 66% of people aged 18 and older wear glasses or contact lenses.
If you are nearing age 65 and plan to enroll in Medicare anytime soon, you may be wondering if your vision needs will be covered.
A simple vision test is included in the “Welcome to Medicare” preventive visit if you are enrolled in Medicare Part B. The vision test is only offered once and must be completed within the first year of Part B coverage.
Outside of this initial vision test, Original Medicare (Medicare Part A and Part B) does not offer routine vision coverage.
Routine vision coverage includes routine eye exams, also known as eye refractions, or fittings for eyeglasses or contact lenses. Therefore, you will pay 100% of the costs out-of-pocket for routine eye exams unless you have a Medicare Part C or Medigap plan that covers these costs.
Some preventive eye screenings, such as glaucoma tests and treatment for macular degeneration, are covered under Medicare Part B.
What Does Medicare Part B Offer For Vision Care?
Individuals with diabetes or who are at high risk for glaucoma may receive annual eye screening which is covered by Medicare Part B. To be considered high risk for glaucoma, you will need to match the following criteria:
- You have diabetes.
- You have a family history of glaucoma.
- You’re African American and 50 years old or older.
- You’re Hispanic American and 65 years old or older.
You will pay 20% of the Medicare-approved cost for the screening. If you receive the test in an outpatient setting, you will also pay a copayment fee.
Part B coverage also includes diagnostic tests and treatment for specific eye diseases such as lucentis, aflibercept, and ocular photodynamic therapy.
If you have diabetes, Medicare covers an annual vision exam to check for diabetic retinopathy.
If you need cataract surgery, Medicare Part B will cover some of the related costs. Following cataract surgery that includes intraocular lens implants, Medicare Part B does help pay for corrective lenses.
Additional post-cataract services provided by an optometrist may be covered. Only services performed by an optometrist who is licensed in your state may be covered.
Medicare Part B will also cover the following post-cataract costs:
- Standard frames (only).
- Eyeglasses and contact lenses (even if you had the surgery before receiving Medicare benefits).
Following cataract surgery, you are responsible for paying 20% of Medicare-approved amounts for one pair of eyeglasses or one set of contact lenses, after the Medicare Part B deductible.
Outside of medically necessary procedures, Medicare Part B does not cover the costs of glasses or contacts.
Filing A Claim
To file a claim, a prescription order signed by your ophthalmologist or optometrist must be on file with the supplier. Suppliers need to be enrolled in Medicare. In addition, suppliers must meet strict standards set by the government in order to qualify for a Medicare supplier number.
Your claim won’t be approved and paid if your supplier does not have a number or is not enrolled in the Medicare system.
Medicare Advantage Plans And Vision Coverage
Benefits vary by plan, but some Medicare Advantage plans (Medicare Part C) do cover regular eye exams, eyeglasses, contacts, and fittings for frames and contact lenses. Be sure to check with your plan provider to see if vision benefits are included and the related costs.
If you sign up for a Medicare Advantage plan, you will need to continue paying your Medicare Part B premium and you may have an additional premium charge with the Medicare Advantage plan.
To learn more about Medicare and vision coverage, consider speaking with a licensed insurance agent who can provide plan quotes and benefits options.
