My mother-in-law had cataract surgery on both eyes. She just got a new pair of prescription eyeglasses. I thought there was a program for her to get a partial payment on her new prescription glasses. Does she need to fill out a form to do that? Where can I get a form for her? Thank you! -Charlene Simpson
Charlene, You have asked one of the more confusing and possibly misleading questions concerning Medicare coverage. Let me try to put it in perspective as succinctly as possible.
Medicare will cover cataract surgery and one pair of glasses after cataract surgery. However, there are some unexpected quirks to this coverage.
Under Original Medicare, the surgery is covered under Part A if it is inpatient and Part B if it is an outpatient service. The coverage for the pair of glasses is the same for either type of surgery, as they are covered under Part B of Medicare. There are several stipulations made by Medicare as to when and how this glasses coverage is to be offered. One pair of conventional glasses or contact lenses is covered after each cataract surgery with the insertion of an intraocular lens.
This post-cataract eyeglasses benefit covers standard frames, prescription lenses, balance lenses, wide segment, and UV filtration. It will not cover scratch coating or edge treatments, tint, oversize lenses, anti-glare coating, or polycarbonate lenses.
This pair of glasses is covered under Part B of Medicare and the glasses are not free as some suppose. They come with the Part B 20% coinsurance and the Part B yearly deductible ($233 in 2022). This means that a $400 pair of glasses could cost $233 for the copayment if it has not been met, plus 20% of the remaining $167.00 or $33.40 for a total cost to the patient of $266.40. If the yearly deductible has already been met, the cost should be 20%, which is $80.00.
Most Medicare Supplement (Medigap) Plans will cover the 20% coinsurance cost but unless you have an F supplement policy, you are subject to the $233 deductible.
Many Medicare Advantage Plans cover the post-cataract eyeglasses with a $0 copayment.
Depending upon which coverage you have, you can contact Medicare or the customer service department of your carrier and find your payment obligation.
Best regards, Ron