Understanding Medicare Vision Coverage

Whether you’ve worn glasses or contacts your whole life or only started noticing vision changes with age, you know how important it is to take care of your eyes. Insurance carriers typically treat eye health as a supplemental service that requires additional coverage, and in many ways, Medicare does the same. Fortunately, understanding what your plan covers doesn’t have to be complicated. Below are some basic guidelines for vision care under Original Medicare and Medicare Advantage.

‍

Does Medicare Cover Vision Services?

Routine eye care services, including regular eye exams, are excluded from Medicare coverage. However, Original Medicare can be used for vision-related care under some circumstances:

• An eye exam to diagnose a vision problem: If you’re experiencing new or severe vision-related issues due to an illness or injury, you may have a serious eye condition. Medicare Part A will cover an eye exam as part of a hospital stay, even if there’s no diagnosis. 

• Surgical procedures: Procedures needed to repair the eye as the result of a chronic condition, such as a cataract, are covered by Medicare. 

• Eyeglasses or contacts after an intraocular lens procedure: An intraocular lens is placed in your eye after cataract surgery to help refract light. If you have astigmatism or a very strong corrective lens prescription, you may still need help reaching proper clarity and acuity. Medicare will cover the cost of medically necessary glasses and contacts. 

‍

What About Routine Eye Care?

As noted above, Original Medicare doesn’t cover standard ophthalmology services. However, there are some exceptions for common age-related health conditions.

‍

Vision loss is a possible outcome for people with diabetes. If you have this condition or a documented family history of it, Medicare Part B covers one annual exam to diagnose or track related vision problems.

‍

If you have a high risk of developing glaucoma, your Part B coverage includes one annual eye exam. High-risk patients are those with diabetes and a family history of glaucoma, as well as African Americans aged 50 or over and Hispanic Americans aged 65 or over.

‍

Similarly, Part B coverage pays for testing and treatment for macular degeneration. Additional Part D coverage can be used for necessary medications.

‍

Are There Other Options for Vision Care?

Medicare Supplement Insurance (Medigap)

If you rely on Original Medicare to cover most of your health care expenses and are happy with the coverage, adding Medigap helps defray the cost of coinsurance, deductibles, and copays for services covered by Original Medicare. Your Medigap plan does not generally cover routine eye exams, eyeglasses, or corrective lenses, but it may offer discounts for these services.

‍

Medicare Advantage

Medicare Advantage is administered by private insurance companies, and they want to create competitive, attractive policies. This often means including vision care. To obtain this coverage under a Medicare Advantage plan, you must first qualify for Original Medicare. 

‍

All vision benefits available through Medicare Advantage must cover the same services as Original Medicare at a minimum. Medicare Advantage plans are more likely to cover routine services and corrective lenses either free of charge or at a discounted rate. 

‍

Have questions about your vision coverage options under Medicare? We’re available to help. Call or text (888) 443-5336 (TTY: 711) to consult with a licensed Medicare agent. You can also browse our advisor directory to find a local professional.