Eye exams are vitally important for your overall health and well-being, and, for many, glasses are an essential part of everyday life. The truth is some people can’t see without their glasses. And vision gets worse, not better as you get older. The question is, can you get vision health coverage if you are on Medicare?
Eye Health Coverage Under Medicare
Rest assured, Medicare does cover eye health, but the amount of vision health coverage you have depends on your plan.
You have two options available when choosing a Medicare Plan: Original Medicare or Medicare Advantage (Medicare Part C). Original Medicare will only cover treatments for eye illnesses or injury, or exams for people with a high risk of developing an eye-related disease. It does not cover routine eye exams or eyeglasses. If you want full vision health coverage, you will need Medicare Advantage.
Original Medicare Vs. Medicare Advantage
Original Medicare is Medicare Part A plus Medicare Part B. You have the option to add Medigap Supplemental Coverage and Prescription Drug Coverage, or Medicare Part D. Medicare Advantage is a Medicare-approved private insurance plan. It is made up of bundle packages that include all of the benefits you receive with Medicare Parts A and B plus extra benefits like vision, hearing, and prescription drug coverage. You may be able to receive coverage for eyeglasses and routine eye exams through Medicare Advantage.
What Medicare Part A Covers
Medicare Part A is hospital insurance. It will cover:
- Inpatient treatments for eye disease
- Inpatient treatments for eye injury
- Medical emergencies involving eye treatments
- Eye exams related to hospital treatments
- Medications prescribed for inpatient treatments
Once deductibles have been paid, you can expect Medicare to pay for 100% of your hospital bill for all Medicare-covered inpatient medical treatments for up to 60 days. If you are still in the hospital after 60 days, you will be responsible for a daily copay.
What Medicare Part B Covers
Medicare Part B is medical insurance. It covers doctors’ visits, outpatient treatments, medical supplies necessary for treatment, and prevention services. In terms of eye health, Medicare Part B covers:
- Outpatient surgical treatments
- Outpatient post-surgical treatments
- One pair of glasses or corrective lenses for someone who had cataract surgery, but you must get the glasses or corrective lenses from a Medicare-approved supplier
- A prosthetic eye from a Medicare-approved provider
- Outpatient treatments to prevent eye disease or injury
- Annual eye exams for anyone with a high risk of developing an eye disease (such as people with diabetes, glaucoma, or macular degeneration)
After the deductible is paid, you can expect that Medicare Part B will cover 80% of the Medicare-approved costs of Medicare-covered services.
What Doesn’t Original Medicare Cover?
Original Medicare does not cover:
- Routine eye exams
- Eyeglasses
What You Receive with Medicare Advantage
Because Medicare Advantage is a private plan, you will need to closely compare plans to make sure that you receive the vision health coverage you need. As a part of Medicare Advantage, you receive:
- All the benefits you receive in Medicare Parts A and B
- (Most likely) Medicare Part D – prescription drug coverage
Plus, your plan may include:
- Vision, hearing, and dental coverage
- Routine eye exams
- Eyeglasses and other corrective vision products
- Non-disease-related (elective) outpatient surgery, such as corrective laser eye surgery
Medigap
In order to be eligible for Medigap, Medicare Supplemental Insurance, you must choose the Original Medicare plan. Medigap helps with out-of-pocket medical fees, such as copays. It does not include vision coverage
Medicaid
You may be eligible for Medicaid. If so, you may be able to receive coverage for routine eye exams and glasses. It all depends on the state you live in. These are the vision health services Medicaid may possibly cover:
- Treatments for eye injuries
- Treatments for eye diseases
- Preventative treatments
- Symptoms, including prescription drugs
- Routine eye exams
- Eyeglasses
Vision Care Insurance
If you are unsatisfied with the eye health coverage you receive from Medicare, you may want to consider private insurance just for vision. If you do, Medicare will work with other insurance plans. Call the Benefits Coordination & Recovery Center at 1-855-798-2627 or go to Medicare.gov to better understand how Medicare coordinates benefits with other insurance companies and plans.
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