Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
Does Medicare Offer Vision Care?
Vision care can range from getting glasses to cataract surgery. Many Medicare beneficiaries need some level of vision care, so it is important to know how Medicare insurance can help pay for these services.
Original Medicare which includes Part A (hospital insurance) and Part B (medical insurance) does not cover routine vision exams or corrective lenses, but Part B helps cover certain vision-related services if you have eye disease or injury.
Part B vision care coverage is limited to medically necessary treatment for eye problems. Some of the eye conditions covered by Part B are a common, normal part of aging, like cataracts or macular degeneration. Others are associated with risk factors like having diabetes or a family history of glaucoma. For a comprehensive look at what vision care Part B covers read on and learn more on the Medicare website.
Medicare Advantage Plans
You can access these Medicare-covered services through Original Medicare or a Medicare Advantage (MA) plan. MA plans provide the same benefits as Original Medicare does, so if a vision service is covered under Original Medicare Part B, it is also covered under a MA plan.
Most MA plans also include some non-covered Medicare services, such as routine eye exams and financial allowances for corrective lenses. Some Medicare Supplement Insurance (Medigap) plans offer discounted non-covered Medicare vision services as an additional benefit. Both MA plans and Medigap plans are approved by Medicare and are offered by private insurance companies.
Note: You can opt for Original Medicare, plus or minus a Medigap plan, OR you can choose a Medicare Advantage plan. You cannot purchase both a Medigap plan and a Medicare Advantage plan.
If you are looking for non-covered Medicare vision services like help paying for eyeglasses from your MA plan or a discount from your Medigap plan, you can review your plan’s details or talk with the plan’s representative.
What Kind of Vision Care is Covered by Medicare?
Medicare helps pay for these medically necessary vision-related services:
- Cataract surgery if it is 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:
- a family history of glaucoma,
- if you are African American and aged 50 or older, or
- 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 who is legally allowed to do the exam in your state. Treatments may include medications, laser treatments, and surgery.
- If you have age-related macular degeneration (AMD), 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.
Which Medicare Supplements Cover Vision Care, Vision Exams, and Glasses?
Medicare supplements (Medigap) are intended to help fill the “gaps” for out-of-pocket expenses, such as copays, coinsurance, and deductibles incurred when you access your Part A and B benefits. This applies to Medicare-covered services only. For Medicare-covered vision care, for instance, if you see an eye doctor for treatment of glaucoma, your Medigap policy will typically cover the 20% that you are responsible for after Part B pays 80% of Medicare-approved charges, and after you pay your Part B annual deductible.
Exceptions to 100% coverage of your Part B coinsurance or copay are: Plans K and L pay a percentage of your Part B coinsurance or copay and have out-of-pocket yearly limits that apply. Exceptions to Part B annual being your responsibility are: Plans C and F pay your Part B annual deductible, but these plans are not available to people who are newly eligible for Medicare on or after January 1, 2020.
Medigap does not typically cover routine vision exams or corrective lenses because these are not covered by Medicare. Some Medigap plans, however, offer discounted vision exams and glasses as an add-on or extra benefit for their members. Similar to these extra benefits that are offered through Medicare Advantage plans, you must use the Medigap plan’s in-network providers and adhere to the plan’s rules and restrictions. You may need to pay an additional monthly premium to have access to these benefits.
Medigap plans are standardized throughout the country, but not all types of plans are offered in every state. There are manyTo find out exactly what these discounts are, you should contact your plan directly.
Kelly Blackwell, Certified Senior Advisor®
Learn More From Our Sources
- Medicare | Routine Eye Exams | Last accessed July 2021
- Medicare | Eye exams if you have Diabetes | Last accessed July 2021
- Medicare | Glaucoma Screening | Last accessed July 2021
- Medicare | Macular Degeneration Tests and Treatments | Last accessed July 2021
- Medicare | Cataract Benefits | Last accessed July 2021
- Medicare | Supplemental Insurance (Medigap) | Last accessed July 2021
- Medicare | Compare Medigap Plans | Last accessed July 2021
- CMS | Medicare Supplement Health Insurance | Last accessed July 2021
- State Health Insurance Assistance Programs | Last accessed July 2021