Medicare will cover a variety of eye care services, including routine exams, eyeglasses, and contact lenses. However, there are some exceptions, so it’s important to understand what is and isn’t covered. In this blog post, we will discuss the coverage that Medicare provides for eye care services. We will also answer some common questions about Medicare and eye care.

Medicare Advantage

Here is What Medicare Covers

Medicare Part B helps pay for these medically necessary vision-related services:

  • Cataract surgery if it’s done using lasers or traditional surgical techniques. This procedure replaces your cloudy lens, which is the source of your blurry vision, with a clear artificial lens called an intraocular lens (“inside the eye”).
  • Corrective lenses if you have cataract surgery – either one pair of eyeglasses with standard frames or one set of contact lenses from a supplier who is enrolled in Medicare.
  • Glaucoma screening test once every 12 months if you are at risk for glaucoma, which is increased pressure within the eyeball that adversely impacts your sight over time. Risk factors for glaucoma are:
  • Diabetes
  • A family history of glaucoma
  • If you are African American and aged 50 or older
  • If you are Hispanic and aged 65 or older
  • Yearly eye exam for diabetic retinopathy if you have diabetes. Retinopathy is a disease of the retina, the back part of your eyeball that interacts with your optic nerve to form a visual image. This exam must be done by an eye doctor in your state. Treatments may include medications, laser treatments, and surgery.
  • If you have age-related macular degeneration (AMD)
  • x
  • Trusted Source
  • Medicare.gov (N/A)
  • The official U.S. government website for Medicare provides information about plans, coverage, costs, claims, resources, and more to the public.
  • Government Authority
  • Go to source
  • Part B may cover certain diagnostic tests and treatment of eye diseases and conditions. The macula is the small central portion of your retina, and as it wears down, it causes loss of vision. Treatment may include medications, laser treatments, and vision aids.

Does Medicare Cover Ophthalmologists?

As a specialist in the eye and vision care, an ophthalmologist diagnoses and treats eye diseases, provides medical and surgical interventions, and prescribes and fits corrective lenses. Medicare will help pay for ophthalmologist services in cases of medical and surgical concerns related to the eyes. Original Medicare will not pay for routine eye exams or corrective lenses whether you receive them from an ophthalmologist or optometrist.

MA plans with vision benefits will help pay for in-network ophthalmologist services. However, a referral would be required. This would be to see a specialist copay and/or coinsurance for exams or surgical procedures. Contact your plan, discuss your coverage with your vision care provider, or review the EOC or Summary of Benefits for details to determine your benefits and what you have to pay. As well as speak to someone with your plan to confirm

What Plans Are Best For Vision Care?

Medicare Advantage Plans are best if you need vision care. MA plans cover all services that Original Medicare Part B does, plus help with routine eye exams and corrective lenses.

According to the Kaiser Family Foundation, 98% of individual Medicare Advantage Plans and 96% of Special Needs Plans (SNPs) available in the U.S. in 2022 offer some vision benefits. You generally must choose in-network providers and may need to obtain referrals and prior authorization.

Details about vision care benefits you can receive and how much you pay are outlined in each plan’s Evidence of Coverage (EOC) or Summary of Benefits documents. Some plans offer additional vision care coverage for an additional monthly premium.

Here is a comparison chart of five MA insurance companies, all HMO plans, to give you an idea of what non-Medicare vision coverage may be available to you in your area (derived from each plan’s 2022 EOC or Summary of Benefits docs):

Medicare Provider:

Aetna Covers routine eye examines

$90 Reimbursement allowance for lenses

Humana Routine eye exam covered and $100

allowance for lenses

Wellcare Eye Exam covered and $200 allowance

for lenses

Unitedhealthcare Eye Exams Covered as well as $200

allowance for lenses

Cigna Exams Covered 100% and $200 allowance

what-is-Medicare-Supplement

How Much Will Vision Care Cost With Medicare?

With Original Medicare, you pay 100% for eye exams for eyeglasses or contact lenses. If you receive medically necessary vision care, Part B coverage kicks in and you pay 20% of the Medicare-approved amount for doctor’s services after you satisfy your annual Part B deductible ($233 for 2022). If the service is in a hospital outpatient setting, you also pay a copayment. Your total out-of-pocket costs will depend on:

  • Other insurance you may have
  • How much your doctor charge
  • Whether or not your doctor accepts Medicare assignments
  • The type and place you get your test, item, or service

Talk with your provider to find out more about your out-of-pocket costs with Original Medicare. As well as shop around for additional plan options.

Plan of Attack

If you have a MA plan, vision care costs vary depending on your plan. All MA plans offer the same Medicare-covered, medically necessary benefits as Part B. Still, you typically must receive care from in-network providers, and your copay/coinsurance structure may be different.

Some MA plans have a $0 monthly premium (although you still pay your Part B monthly premium of $170.10 for 2022) for vision benefits. Some MA plans offer supplemental vision care coverage for a monthly premium ranging from about $10 to $70. Most MA plans with vision care have an allowance that you can apply toward the purchase of either eyeglasses or contact lenses. As well as the amount can range from $100 to $200. Any other costs related to corrective lenses are your responsibility.

Whether you have Original Medicare or a MA plan. Vision if medically necessary, can be considered to be a covered benefit. You are eligible to receive services from approved providers, and you may be responsible for a portion of the costs in the form of a copay or coinsurance. In addition make sure the provider is in network or will accept network discounts.

If you need any vision care. Please give us a call. That way we can point you in the right direction.