Throughout our working lives, we are often provided vision benefits through our employer group health insurance. It can come as shock at age 65 to find out that Medicare does not include benefits for routine vision services. It does, however, provide for treatment of illnesses or injuries to the eye.
Let’s look at the various ways you can get your vision coverage once you are on Medicare.
Medicare Part B Coverage of Vision
Your Original Medicare benefits include Part A hospital insurance and Part B outpatient insurance. Treatment for health conditions or injuries affecting the eye is covered by Part B just like any other health condition.
If you need treatment for conditions like glaucoma, cataracts, macular degeneration or even minor things like pink-eye, Medicare Part B will cover this treatment at 80% after you first pay the small annual Part B deductible.
Medicare Part B also covers yearly preventive and diagnostics exams that screen for conditions like glaucoma or macular degeneration. Should you have surgery for cataracts, Medicare Part B will pay for a pair of basic eyeglasses afterward as well.
It’s important to know that these are standard basic lenses. If you choose to upgrade those lenses with anti-scratch coating or tinting, or you want Gucci frames, you will pay the difference for those additions.
For everyone else, Medicare does not cover is routine eye exams, called eye refractions, for the purpose of getting eyeglasses. Medicare also does not cover the cost of a low vision refraction, (low vision exam) aids, devices and techniques that help people maximize existing vision. Treatment at a low vision clinic will be at your own expense.
One exception to the routine eye exam rule is for diabetics. Medicare will cover routine eye exams to check for disease related to diabetes. In addition, Medicare will cover glaucoma screenings every twelve months for high-risk people, including diabetics, people with a family history of glaucoma, African Americans age 50+ and Hispanics age 65+.
How to Get Help with Vision Coverage
So how do you pay for these items? Well, the private insurance market offers a variety of standalone dental, vision and hearing insurance plans. You can search on Google for individual vision plans or senior vision plans, and you’ll find a number of plans that you can consider. Most of these plans will require you to seek treatment from a network of providers. There are some plans, however, that work on a reimbursement basis and will cover a certain percentage of your costs according to the plan rules, regardless of where you seek your care.
Another option for vision coverage is Medicare Advantage plans. Some Medicare Advantage plans provide extras that Original Medicare itself does not offer. This may include things like routine dental, eye exams, and corrective lenses, and hearing exams and hearing aids.
It’s important to review the plan’s Summary of Benefits. While on the surface, routine vision coverage might sound good, but plans vary as to what they cover. Some plans cover just an eye exam, for which you will pay a doctor copay. Other plans will offer some coverage for the eyeglasses or contacts but be sure to read the fine print. It’s not uncommon for plans to limit that benefit to a maximum payout of $100/year or so. Eyeglasses can often cost two or three times that amount.
You also often have to get this treatment at vision centers that are in the network. Be sure to check your plans’ directory before getting your eye exams or lenses so that there is no sticker shock.
Lastly, before you enroll in any coverage for vision, check with your local Sam’s Club, Costco or Walmart. Sometimes these retailers have low-cost vision exams and discounted lenses and frames for members or seniors. If you find these rates affordable, you may not need to purchase additional coverage.