Does Medicare Cover Eyeglasses and Vision Care?

Does Medicare Cover Eyeglasses and Vision Care?
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Does Medicare Cover Eyeglasses and Vision Care?

Does Medicare Cover Eyeglasses and Vision Care?
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182 million Americans use some form of vision correction. And glasses become far more common as you get older. 

But while glasses can effectively improve your vision, they are also expensive. VSP, the leading provider of employer eye care benefits, says the average cost of an eye exam, frames, and lenses is $576. 

And it’s not just a one-off payment. It’s recommended that you change your glasses every two years, so costs soon add up.

Unfortunately, Medicare does not cover the cost of eyeglasses or routine eye exams in most situations, although you may be covered in some specific cases. 

Key Points

  • Medicare does not cover routine eye exams.
  • Medicare does not cover prescription glasses and lenses in most cases.
  • The exception is following cataract surgery, when it will cover a single pair of glasses or set of lenses.
  • Medicare does not cover LASIK surgery.
  • Medicare covers eye exams for specific conditions such as glaucoma and age-related degeneration when deemed medically necessary.

What Is Medicare?

Medicare is the U.S. health insurance program for people who are 65 or older, some young people with disabilities, and those with End-Stage Renal Disease.

The federal Medicare program provides coverage for many health issues. It isn’t strictly required that you sign up for Medicare, but almost all people who are eligible are covered by at least Part A and B.

Medicare coverage is split into four parts:

  • Part A is hospital coverage. It helps with stays in hospitals and skilled nursing facilities, and some home and hospice care.

  • Part B is medical coverage. It helps pay the cost of visits to the doctor, supplies, and other medically necessary services. 

  • Part C, also known as Medicare Advantage Plans, is Medicare cover bought through a private insurer. It includes Parts A and B and typically also offers extra benefits.

  • Part D is prescription drug coverage. This is an optional plan that covers the cost of prescription drugs. 

Part A and B are known as Original Medicare. Many private insurance companies also offer Medicare Supplement Plans, known as Medigap Plans. These provide coverage for the out-of-pocket expenses associated with Medicare. 

Terms You Need to Know: 

Out-of-pocket expenses: This term refers to costs that are not covered by Medicare and that you must pay for yourself. For example, a fee for a visit to the physiotherapist. 

Deductible: A deductible is an amount you must pay for health treatment, services, or items before your Medicare insurance starts paying for costs.

The Medicare Part A deductible is $1,556.00 per benefit period in 2022. 

The benefit period for Part A starts when you are admitted as an inpatient and ends when you haven’t received related treatment for 60 consecutive days.

The Medicare Part B deductible is $233.00 per benefit period in 2022. 

Part B’s benefit period is annual, meaning you only have to pay your Part B deductible once a year.

You will have to reach or pay these amounts before Medicare covers any of your expenses. 

Does Medicare Pay for Eye Exams?

Medicare does not cover routine vision care such as eye exams and eye refractions for glasses and contact lenses. In most cases, you have to pay 100% of the costs of these services. 

However, Medicare Part B will cover some types of medically necessary eye exams. 

Diabetes

If you have diabetes, Medicare will cover an annual eye exam to check for diabetic retinopathy. 

Cataracts

Medicare will pay for a cataract eye exam if your doctor believes it is medically necessary.

Glaucoma

Medicare will pay for an annual glaucoma test if you are at risk of developing the condition. People who are considered high risk include:

  • Individuals with a family history of the disease

  • People who have diabetic retinopathy

  • African-Americans aged over 50

  • People of Hispanic descent who are aged over 65

Age-Related Macular Degeneration

Age-related Macular Degeneration is a condition that affects people as they get older. It typically results in blurred vision in one or both eyes. Medicare will cover diagnostic eye exams related to the condition whenever your doctor believes they are medically necessary. 

In these cases, Medicare Part B will pay 80% of the Medicare-approved amount once you meet your deductible. You pay the rest. 

Are You Worried about Unexpected Costs?

Speak to your health care provider if you are worried about the price of a vision procedure or whether Medicare covers it. 

The exact price of a service will often vary depending on the type of procedure, how much the doctor charges, other insurance policies, and the health care facility. 

If you’d like to find out if you can save on your medical expenses, contact PolicyScout to find out more. 

Does Medicare Pay for Eyeglasses or Contact Lenses?

Medicare does not typically cover eyeglasses or contact lenses. This means if you have Original Medicare (Parts A and B), you will have to pay 100% of the costs of prescription glasses and contact lenses. 

The one exception is that Medicare Part B will contribute towards one pair of standard frames or one pair of contact lenses following cataract surgery

Medicare will pay 80% of the cost of the Medicare-approved amount for these glasses or lenses once you have met your deductible. Remember, this amount is set at $233 in 2022. 

You will have to pay the remaining 20% for the glasses or contact lenses.

You can also choose to buy glasses that cost more than the Medicare-approved price. In this case, you will be responsible for any additional costs.

Just remember that Medicare only covers a single pair of glasses or lenses. You will have to pay full price for any future glasses.

Does Medicare Cover LASIK Surgery?

Laser eye surgery effectively deals with many common eye issues, including nearsightedness, farsightedness, and astigmatism. 

Original Medicare does not cover this procedure as it doesn’t consider it a medically necessary surgery. You’ll have to pay the full price for LASIK if your only health coverage is Original Medicare.

Some Medicare Advantage Plans with additional vision benefits may help you with LASIK surgery. As each plan differs, you should check your documentation to find out more. 

If you’d like to explore plans that offer this coverage, click here to see what is available in your area. 

What Is a Medically Necessary Procedure?

Medicare only covers procedures that it considers to be medically necessary. Medicare defines these as:

“Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”

Other Vision Care Procedures Covered by Medicare

Medicare will cover some vision and eye-related procedures when it is deemed medically necessary. 

These include:

  • Cataract surgery and related services pre and post-procedure

  • Eye infections such as conjunctivitis

  • Allergies that affect the eyes

  • Injuries to the eye and surrounding area

Medicare Part B typically covers 80% of the cost for these services. This means you’ll pay 20% of the cost of procedures once you have met your deductible.

For example, if the cost of cataract surgery is $4,000, Medicare will pay $3,200 and you will have to pay the remaining $800.

Part A will cover you if your eye issues require a hospital stay. In this case, you will be covered for the first 60 days of your hospital stay once you meet the deductible, which is currently set at $1,556.

Medicare Part C (Medicare Advantage Plan) and Vision Care

Medicare Part C, also known as Medicare Advantage, is a way to get Medicare coverage through a private insurance company. Every Medicare Part C plan has to include Original Medicare, but they often come with additional coverage. 

Most Medicare Advantage plans offer additional benefits and cover which may include vision care. 

This means you may be covered for routine eye tests and prescription glasses and lenses if you have a Medicare Advantage Plan already. You may have to get your vision care through one of its providers, or it may allow you to go through any network. 

The key point is that all Medicare Advantage Plans are different. If you already have a plan, consult your paperwork or speak to a representative to see covered vision benefits. 

If you don’t have a plan but are interested in getting one, click here to compare your options

Medicare Supplement Plans (Medigap) and Vision Care

Medicare Supplement Insurance Plans (Medigap) are insurance plans with private companies that cover some of Medicare’s out-of-pocket expenses. They are only available for people with Original Medicare, and not those who have a Medicare Advantage Plan.

These plans will help you pay the deductible and coinsurance of Medicare-approved vision procedures and services, but the exact amount will depend on your plan. 

Medicare Supplement Plans do not provide any additional Medicare vision coverage compared to what you get with Original Medicare.

Medicare Coverage Is Limited for Vision Treatments

Medicare does not cover eyeglasses and vision care in most cases. If you have a specific issue that your doctor deems medically necessary it will help, but you aren't covered for routine eye exams.

You can sign up for private insurance or a Medicare Advantage Plan with vision coverage to get extended vision coverage. Find out more about how PolicyScout can help you get the best plan for your needs by clicking here.

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