We often take our eyesight for granted, especially in our younger years. But as we age, regular vision care is essential for maintaining our overall health and preventing eye disease. One question many people ask is, “Does Medicare Cover Vision Care?”
Original Medicare and Vision Services
First, let’s start by talking about what Original Medicare covers for vision. Original Medicare consists of Part A and Part B. Part A covers hospital stays, while Part B covers outpatient services.
Vision coverage under Medicare is quite limited, but it does pay for a few select services. All of these fall under Medicare Part B.
- Glaucoma Tests: Annual glaucoma tests are covered by Medicare if you are at high risk for the disease. People at high risk include those with diabetes, a family history of glaucoma, African Americans aged 50 or older, and Hispanic Americans aged 65 or older.
- Macular Degeneration: Part B covers diagnostic tests and treatments (like injections) for age-related Macular Degeneration.
- Cataract Surgery: Medicare covers cataract surgery to remove a cataract, as long as it’s performed using traditional surgical techniques or lasers. In addition, Part B will cover one pair of glasses or contacts following the surgery.
All of these services are subject to the annual Part B deductible, as well as a coinsurance amount. If you have a Medigap plan, it will also cover these services and take care of some of those out-of-pocket costs. However, Medigap plans do not offer any additional vision coverage.
Medicare Advantage and Vision Services
Medicare Advantage plans, also known as Medicare Part C, offer an alternative solution to Original Medicare. Private insurance companies that have been approved by Medicare sell these plans as a way to bundle your benefits from Original Medicare. In most cases, they offer additional coverage like prescription drug benefits, dental care, wellness programs, and vision coverage.
All Medicare Advantage plans must have at least as much coverage as Original Medicare. So, that means that all the services we listed above will also be covered by a Medicare Advantage plan. (Although your copays will be different.)
In addition to those services, you may have even more vision coverage. For example, many plans cover routine eye exams once a year. Plans may also cover glasses or contact lenses as a standard benefit, not just after cataract surgery.
Of course, every Part C plan is different, so you’ll need to read the plan’s summary of benefits or evidence of coverage to find out which vision services are covered by the plan.
Other Options for Vision Coverage
If you don’t have a Medicare Advantage plan that includes extra vision coverage, you may want to consider a separate vision insurance plan.
Sometimes, Medicare beneficiaries like to purchase a plan that includes coverage for dental, vision, and hearing services since Original Medicare does not offer benefits for these three services. If vision coverage is important to you, be sure to find a plan that provides robust vision coverage.
Lastly, many states have assistance programs available to lower-income individuals who need help covering the cost of their vision care. Programs vary by state but can provide significant help to ensure you get the vision services you need.
Remember, Medicare is not a one-size-fits-all. The best plan for you depends on your health circumstances and financial situation. Make sure you take the time to research all options and consider seeking the help of a trusted advisor like the ones at Carolina Senior Benefits. Call today and schedule a consultation with our Medicare experts!
