Does Aetna Medicare Cover Eye Exams

How Much Does Medicare Cost

The cost of Medicare depends on what you need.

Original Medicare is the cheapest option. Medicare Part A, which covers hospital services, typically has no monthly payment if you paid taxes to Medicare for a specific period. Most people get free Medicare Part A.

Medicare Part B covers outpatient services this is what usually covers Medicare-approved vision services. Part B has a deductible of $203 per benefit period . Additionally, monthly payments must be met .

Once your deductible is met, Medicare Part B covers 80% of approved health services. Youll have very affordable prices for most treatments and services.

The price of Medicare Advantage is difficult to estimate before you sign up for a plan. Youll at least have the same monthly payment as Medicare Part B . However, the price of Medicare Advantage can vary depending on the coverage.

Aetna Medical Plans And Coverage Costs

On the Aetna Medicare solutions page, you can search specific coverage information for your location. Youll realize that coverage costs vary by location and some plans may not be available in certain counties or states.

Your out-of-pocket expenses will also depend on the specific Aetna plan you have.

For example, the Aetna Medicare Dual Preferred Plan is one of the coverage options for Alabama residents. In this state, the plan is only available in five counties, including Montgomery, Dallas, and Mobile.

HMO D-SNP covers multiple medical issues, including eye care, and it costs up to $27.2 in monthly premiums. With this plan, you can pay up to $7,550 out of pocket per year.

Youll usually pay nothing or 20% of eye exams under this plan. These tests include diabetic eye and glaucoma screening.

If you live in certain counties in Texas, for example, your coverage options include the Aetna Medicare Choice II Plan . As with most other Aetna plans, only a handful of counties in this state offer this package, including Austin, Brazos, and Grimes.

The monthly premium for the PPO is $15 and the maximum out-of-pocket amount for the year is $7,550. This plan pays the full cost of glaucoma screening, but diabetic eye exams may cost you up to $40.

A routine eye exam is free under this plan, but only once per year. So, youd have to pay out of pocket for any additional routine checkup.

Billing For Routine Eye Exams On Aetna Patients

· You must get care from a provider who accepts Medicare assignment in order to be covered. Youll generally also pay 20% of allowable charges plus any applicable Part B deductible. Does Medicare cover routine eye exam costs? Except in the circumstances noted above, there is generally no Part B coverage for routine eye exams and vision checks.

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Costs For Vision Coverage In Aetnas Medicare Advantage Plans

If youre enrolled in one of Aetnas Medicare Advantage plans, its important to follow the rules of your plan to keep your costs down. Some of Aetnas Medicare Advantage plans, such as health maintenance organizations , may require you to use network providers to be covered, except in cases of emergency care, out-of-area dialysis or urgent care. Other types, such as PPO or HMO point-of-service plans, may let you go out of network for a higher cost.

When it comes to routine vision coverage, some of Aetnas Medicare plans may wrap this coverage into the cost of the plans premium, while others may cover vision services as an optional supplemental benefit . Again, costs and benefits vary for each of Aetnas Medicare Advantage plans, so always check the details for your specific plan.

Please note that some of Aetnas Medicare Advantage plans may have a monthly premium while others might have a $0 premium. However, in either case, youll need to keep paying your Medicare Part B premium.

Does Aetna Pay For Eye Exams

Original Medicare, which is the traditional fee-for-service U.S. government program, excludes routine vision care such as an annual eye exam and corrective lenses. However, Medicare benefits cover the fees charged by both ophthalmologists and optometrists for covered services for example, an ocular illness or injury to the eye.

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Which Medicare Plans Are Best If You Need 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, 91% of Medicare Advantage plans available in the U.S. in 2021 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 plans Evidence of Coverage document.

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 :

You can search for plans on the Medicare website. If you anticipate the need for vision care and corrective lenses, its a good idea to check with your eye care provider to see if they are in-network with the plan you choose.

Does Medicare Pay For Glasses And Contact Lenses

Original Medicare does not routinely pay any share of the cost for glasses, lenses, frames or contacts. Medicare enrollees who need exam services, fittings and prescriptions for glasses or contacts filled are technically 100% responsible for their own costs.

Part B does, however, offer assistance for beneficiaries who have had cataract surgery.

If an intraocular lens is inserted during this procedure, then Part B can help pay for corrective lenses after surgery. Beneficiaries may order a single pair of glasses through an authorized provider, and extra features are not paid for. Extra features include lens tinting and blending, ultralight and unbreakable frames, light-sensitive tint and other optional add-ons. Medicare enrollees must pay 100% of the cost of optional upgrades.

Unlike the other screening and treatment services, all Medicare Part B enrollees are covered for cataract-related treatments, including screenings and surgery. As with all Part B benefits, Medicare enrollees must pay their annual deductible, which in 2020 is $198 for the year, and then typically 20% of remaining costs for all services Part B covers.

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Direct Member Reimbursement Benefits

Plans that offer benefits through a direct member reimbursement provide you with an annual allowance to use toward the costs for covered services provided by a licensed provider of your choice. Members will pay out of pocket at the time they get care and then send us information like a receipt and reimbursement form to get reimbursed up to the plans allowance.

How Much Does Vision Care Cost With Medicare

Vision care costs depend on what your needs are and what type of Medicare insurance you have.

With Original Medicare, you pay 100% for eye exams for eyeglasses or contact lenses. If you receive vision care that is medically necessary, Part B coverage kicks in and you pay 20% of the Medicare-approved amount for doctors services after you satisfy your annual Part B deductible . 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 charges
• Whether or not your doctor accepts Medicare assignments
• The type and place you get your test, item, or service

To find out more about your out-of-pocket costs with Original Medicare, talk with your provider.

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

Whether you have Original Medicare or a MA plan, medically necessary vision care is considered a Medicare-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.

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What Other Vision Benefits Does An Aetna Plan Include

In addition to cataract surgery, Aetna vision insurance and Aetna Medicare Advantage plans can often include coverage of annual eye exams, glaucoma screenings, eyeglasses and contact lenses and discounts on LASIK eye surgery.

Aetna individual and employer-based plans generally require vision coverage to be added on as a standalone benefit. In Aetna Medicare Advantage plans, vision benefits are usually included at no extra cost.

Who Accepts Medicaid For An Eye Exam

Many eye care practices accept Medicaid for an eye exam, as long as it falls within the coverage schedule.

For instance, if your state covers only one eye exam every three years and you schedule an appointment after two years, that eye exam will not be covered. There are exceptions, such as if you have an underlying condition that qualifies you for more frequent exams.

To find eye care practices in your area that accept Medicaid, use All About Vision’s Doctor Locator, which lets you search for eye doctors who accept your vision insurance. The locator will list eye doctors near you who accept Medicaid then you can schedule an appointment.

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Medicare Advantage Plan Types

Medicare Advantage plans may include various types of plan, offering different levels of coverage and availability. The list below looks at these in more detail.

• Health Maintenance Organization plans use a network of healthcare providers, and people can choose a primary care physician to coordinate their care and issue specialists referrals.
• Health Maintenance Organization Point-of-Service plans allow members to use out-of-network care at a higher cost.
• Preferred Provider Organization plans also use a provider network, but members do not need to select a primary care doctor or require specialist referrals.
• Private Fee-For-Service plans have members who pay an agreed amount for care.
• Special Needs Plans are for people with specific disabilities or chronic health conditions or those who have Medicare and Medicaid.

People can find out which Medicare Advantage plans are available in their area by using the governments plan finder tool.

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Does Medicare Cover Refraction

When you visit your optometrist or ophthalmologist to get a new eyeglass prescription, you have what is called a refraction exam. This is basically a vision test that determines whether there is a problem with the way light rays focus as they are passing through the cornea and retina of each of your eyes. These abnormalities are commonly known as farsightedness, nearsightedness, and astigmatism.

A refraction exam helps your physician determine if you need prescription lenses, or a change in your current prescription lenses. It also helps the physician diagnose the presence of eye disease in some instances.

During a refraction exam you look through a phoropter at letters on a chart. Using this machine, the optometrist switches back and forth to different lenses and you decide which one makes the letters on the chart appear sharper to you. This is how the physician determines your optimum lens prescription to attain 20/20 vision, or as close to that as possible.

Because a refraction exam is most commonly associated with routine annual vision checks, your Original Medicare coverage may not cover the costs. However, some Medicare insurance plans may cover these type of eye exams in certain circumstances. It is important to find out the details of what coverage you have with your Medicare insurance policy.Medicare Coverage of Refraction Exams

Costs of a Refraction Test

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How Much Does An Aetna Medicare Advantage Plan With Vision Coverage Cost

As with most Medicare Advantage plans, the cost of a Medicare Advantage plan from Aetna may vary according to location, benefits offered and other criteria.

You can use the Medicare Plan Finder tool to see how much an Aetna Medicare Advantage plan with vision benefits might cost in your area.

The following table provides some examples of what you might pay for an Aetna Medicare Advantage plan with vision coverage in Miami-Dade County in Florida and Maricopa County in Arizona.

Aetna Medicare Vision Coverage

Do Medicare Supplement Plans Cover Eye Exams

Medicare Supplement plans help pay your out-of-pocket costs under Part A and Part B. If Medicare covers a service, its also covered by your Medicare Supplement plan. If its not covered by Part A or Part B, it wont be covered by Medigap.

In other words, Medicare Supplement plans cover eye exams only in the situations listed above.

Dont count on your supplement plan to pick up the difference between Medicare-approved frames and an upgraded pair of eyeglasses. Medigap plans generally pay only your share of the Medicare-approved amount for an item or service. For example, if Medicare allows $100 for a pair of glasses and you choose a pair that costs $125, your Medicare Supplement plan will only pay 20 percent of the allowable charges . Youre still on the hook for the difference.

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Choice Savings And Convenience

When it comes to choosing a vision plan for you and your family, how it fits your life and budget matters. In this video, youll learn how Aetna Vision Preferred offers maximum choice, savings and convenience. Even experts and members agree.

*Aetna Vision Preferred data as of June 2020.

**Offers subject to change. Terms and conditions apply. Visit aetnavision.com for more details and instructions.

***Lenses intended for ongoing, daily-wear use, including rigid gas-permeable lenses.

A Quick Guide To Benefits On The Chart

• Hospital coverage: Benefits for hospital stays and inpatient procedures.
• Visits to doctors and other health care professionals: Coverage for seeing a health care professional as an outpatient.
• Preventive care coverage: Benefits like annual physical exams, certain vaccines and some health screenings.
• Prescription drug coverage: Benefits for prescription medication.
• Coverage while traveling abroad: Benefits for medical care received outside the United States.
• Dental coverage: Benefits for routine care for your teeth.
• Vision coverage: Benefits for routine care for your eyesight.
• Hearing coverage: Benefits for routine care for your hearing.
• Fitness membership benefits: Benefits for gym or fitness club memberships.
• Out-of-pocket maximum protection: A benefit that protects you from paying more than a certain amount for your covered medical care each year.

* Medicare Parts A and B do not include prescription drug coverage, which is provided through Medicare Part D. You are not required to enroll in Medicare Part D. However, if you do not have prescription drug coverage through another plan and choose not to enroll in Part D when you first become eligible, you could end up paying a penalty for late enrollment if you decide to enroll in Part D later.

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Does Medicare Pay For Eye Exams

Vision care costs can break your budget if you dont have insurance that covers them. Find out when Medicare pays for eye exams and glasses, and learn about other vision plan options.

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Even if you dont wear glasses, its good to know the basics of Medicare eye exam coverage.

The American Academy of Ophthalmology recommends regular routine eye exams for older adults, especially since vision changes can be an early warning sign for high blood pressure, diabetes, and serious eye diseases that can lead to vision loss.

Original Medicare pays for eye exams and glasses in certain situations, but limited coverage is available for routine eye care. Heres what you need to know about Medicare and vision coverage.

How Often Does Medicaid Pay For An Eye Exam

States are required to adhere to the recommended schedule for child and adolescent vision and hearing screenings.

All screenings must meet a certain standard of medical practice, which is determined by a credible pediatric health organization, such as the American Academy of Pediatrics.

For adults over age 21, the frequency of covered eye exams depends on which state you live in. On average, an eye exam is covered approximately every two or three years.

To get the most accurate information for your states Medicaid practices, contact a Medicaid representative in your states designated region.

TIME FOR AN EYE EXAM UNDER YOUR STATE’S MEDICAID PROGRAM? Find a local eye doctor who accepts Medicaid coverage.

Schedule an exam

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How To Choose The Best Medicare Advantage Plan

Before choosing a Medicare Advantage plan, one should use the governments Medicare Advantage plan comparison tool to evaluate and compare plans. Things to consider before deciding on the best supplemental Medicare plan:

Cost:

• How much are they willing to spend monthly on a premium?

• What do they want their deductible to look like?

Coverage:

• Will their prescriptions be covered under this plan?

• Is additional coverage offered for services such as dental, vision, or hearing?

• Will their current doctors or specialists be covered?

Convenience:

• Where is their insurance office in case they need assistance?

• Does their insurance provide transportation to and from healthcare appointments if needed?

Note: Oak Street Health provides transportation to and from healthcare appointments for patients that need assistance. They also have providers that are trained and willing to guide patients through their insurance benefits whenever needed.

Does Medicare Pay For Glasses Or Contact Lenses

Medicare generally doesnt cover any costs associated with prescription eyewear. One exception is if you have cataract surgery with an intraocular lens implant in that case Medicare does cover one pair of glasses or contact lenses.

You pay 20 percent of the allowable charges after you meet your Part B deductible. Note: You do have to buy your glasses from a Medicare-approved supplier and choose from Medicare-approved frames. If you upgrade to more expensive frames, you must pay the difference between the cost of the Medicare frames and the upgraded frames in addition to your 20 percent coinsurance amount.

This is a one-time-only benefit. If your prescription changes a year or two after cataract surgery, you have to pay the full cost of your new glasses.

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