As we age, the chances that we will require some type of corrective vision care increases. If you already wear glasses, you know that getting a routine exam and new glasses or contacts can be expensive.
If you were hoping that being enrolled in Medicare would mean that you could get a routine eye exam, glasses or contacts, you are going to be disappointed. Medicare vision coverage is very limited. Like Medicare dental coverage, Medicare eye benefits are geared more towards treating a disease or injury than providing routine maintenance.
This article will address what is covered and what is not. We’ll also look at alternative ways to get vision benefits, the costs of alternative care and the limitations of some vision programs.
Eye care that is covered by Medicare
The discussion of what is covered is related to what is covered by original Medicare. We’ll also take a quick look at coverage if you are enrolled in a Medicare Advantage plan or have purchased a Medicare supplement policy.
Here’s what’s covered:
- Glaucoma Screening once every 12 months. You must pay 20%.
- Eye Care after cataract surgery (even if surgery was be fore you were Medicare eligible) including cataract glasses, contact lenses or interocular lenses provided by an ophthalmologist. You pay 20%
- Treatment for macular generation is provided for some patients with age-related macular degeneration. You are responsible for 20%.
- Eye prostheses and maintenance is covered. You must pay 20%.
Refer to the Medicare and You Handbook or visit medicare.gov to get the specific details of coverage for the above listed procedures.
As you can see, there is no mention of routine eye exams and required glasses or contacts. If you are enrolled in original Medicare, you are on your own when it comes to paying for these products and services.
You may be thinking to yourself that it’s not very fair that these services are not covered by Medicare. Keep in mind that when Medicare was first enacted it was designed to be a safety net not an all inclusive program. Like it or not!
Vision coverage with a Medicare Advantage plan or Medicare supplement
Most people either supplement their Medicare coverage by purchasing a Medigap policy or they receive their Medicare benefits by enrolling in a Medicare Advantage plan. Here’s what you can expect with either type of Medicare plan:
Vision Benefits with a Medicare Advantage Plan
When you enroll in a Medicare Advantage plan you are still enrolled in original Medicare but receive your benefits from a private insurance company that is contracted with CMS. Companies that offer Medicare Advantage plans have the latitude to provide benefits beyond what would normally be available with original Medicare. Vision coverage is often one of those benefits.
This does not mean that all Advantage plans include vision benefits nor does it mean that benefits are actually in the form of insurance. Benefits may be in the form of discounts on products or services. There is no standardization and it’s your responsibility to review benefits from plans you may be considering.
Vision coverage available from a Medicare Advantage plan may be included or may be available in the form of an optional rider that requires an additional premium. If a premium is required, the benefits are probably in the form of actual insurance (which is better) rather than merely a discount.
Vision Benefits with a Medicare Supplement (Medigap Policy)
When you buy a Medicare supplement, you choose from one of several standardized insurance policies that are designed to fill the gaps of original Medicare. But herein lies the confusion.
The gaps are in the form of payment for services, not the services themselves. So the plan may pay the 20% portion of Medicare-covered services that would normally be your responsibility.
The key phrase is, Medicare-covered services. Remember that routine vision care is not a Medicare-covered service. That said, Medicare
supplement policies generally do not cover routine vision.
A company selling Medicare supplemtental insurance may include some ancillary vision benefits so as to sweeten the pot so to speak to give them a competitive edge in earning your business, but it’s not required.
For instance, when you purchase an AARP-branded Medicare supplement from UnitedHealthCare you often receive some vision benefits. These benefits are technically not Medigap benefits, but rather ancillary benefits. Either way… take them and use them!
Bottom line on Medicare eye benefits
Unless you are actually paying extra fro vision benefits, the coverage will often be limited and may only afford you a small discount. You will also normally be limited to a network of providers where you can utilize your benefits.
The other option is to purchase stand-alone vision insurance. Should you choose to do so, review the limitations, waiting periods and deductibles. Often when you factor in the premiums and how often you would use such benefits, you may be better off self-insuring.
Hopefully this helps you understand what Medicare vision benefits are available and options on securing coverage. The limited nature of what eye-related coverage you have with Medicare is good reason to factor it into your budget as a regular expense, so when it arises it will be less painful.