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, 98% of individual Medicare Advantage Plans and 96% of Special Needs Plans available in the U.S. in 2022 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 or Summary of Benefits documents. Some plans offer additional vision care coverage for an additional monthly premium.
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 :
|Medicare Advantage Plan Provider|
|UnitedHealthcare||Routine exams covered $200 allowance for lenses every year.|
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 Plan F Cover Eyeglasses
The way that Medigap plans, including Plan F, work is that they cover only after Medicare first pays its share. … Medicare will, however, pay for one pair of very basic eyeglasses after a cataract surgery. One exception is that Medicare supplement Plan F will cover up to $50,000 in foreign travel emergency benefits.
Medicare And Eye Surgery
Routine eye care is essential at any age but becomes critical when we reach our senior years. One in every three people is at risk for suffering from a vision-related condition by the age of 65. It is why regular eye screening is recommended for seniors.
Common causes of vision loss among seniors are glaucoma, diabetic retinopathy, and cataract.
Medicare, in general, does not cover vision care but will pay for medically necessary services such as cataract surgery. These services are covered under Original Medicare Part B . Medicare covers certain eye services for chronic eye conditions, including cataracts or glaucoma.
Eye surgery for chronic eye conditions that helps repair or restore normal eye functioning is covered under Medicare. It includes surgery to remove a cataract and to replace an eye lens with a fabricated intraocular lens.
Medicare will also pay for a standard pair of prescription eyeglasses or contacts if needed after eye surgery. In some cases, coverage includes customized eyeglasses or contact lenses if deemed necessary.
Medicare covers eye surgeries for cataract regardless of the procedure. It covers eye surgeries, whether it is performed using the latest computer-controlled lasers or traditional surgical techniques. No matter the treatment employed, Medicare covers and pays for the removal of the cataract and insertion of a conventional intraocular lens.
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Does Medicare Advantage Pay For Eye Exams And Glasses
Medicare Advantage is private insurance coverage, which means that its an alternative way to get your Medicare benefits. By law, it has to cover everything Original Medicare covers. At a minimum, Medicare Advantage covers eye exams whenever theyre covered by Original Medicare.
Most Medicare Advantage plans do include extra benefits such as routine vision and dental care. Since Medicare Advantage plans compete for new members, its in their business interest to offer extra benefits that are important to Medicare beneficiaries.
Because routine eye care isnt a standard Medicare benefit, plans can structure their vision coverage in different ways. Some pay the full cost of annual eye exams with network providers, others pay a flat amount toward care with any provider, and others offer discounts on eye exams and eyewear. Check the plan brochures to compare benefits.
You can use the Medicare Plan Finder to search for Medicare Advantage plans with vision coverage in your area. Medicare brokers are another good resource for information about local plans and provider networks.
Keep in mind that plans often change their benefits, so a plan with eye exam coverage this year may have different benefits next year. Be sure to read your Annual Notice of Change each fall so you know what to expect.
Medicare Supplement Plan G: What You Need To Know Before Enrolling
Before you can sign up for Plan G, you must enroll in both Medicare Part A and Part B. The best time to enroll in Plan G is during your Medigap Open Enrollment period. Thats the six months immediately after you turn 65 and sign up for Part B, when youre guaranteed by federal law to be accepted by any plan, regardless of health. You can enroll in or switch Medicare Supplement plans at other times, but the insurance companies can deny you or charge you more based on your health.
Most Medigap plans are standardized across the nation. However, if you live in Massachusetts, Minnesota, or Wisconsin, different types of plans are available. Contact one of our licensed insurance agents or your local state insurance department to help you understand your options.
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Medigap Plans Can Help Cover Medicare Deductibles Copays And More
The 10 standardized Medigap plans that are sold in most states provide up to nine different benefits, but do not include dental and vision coverage. Medigap policies help cover some of the out-of-pocket costs tied to Original Medicare, such as deductibles, copayments and coinsurance.
According to Medicare.gov, Medigap policies generally dont cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
However, if you suffer a dental emergency and must visit the hospital, a Medicare Supplement Insurance plan may provide coverage for Original Medicare deductibles, copayments or coinsurance that you may face.
Does Medicare Cover Vision And Glasses
Original Medicare does not cover routine vision exams or glasses, but Part B helps cover certain vision-related services if you have eye disease or injury.
Medicare Advantage Plans, an alternative to Original Medicare, provide the same coverage as Part B, plus more. Most MA plans offer some coverage for routine eye exams and corrective lenses.
Part B vision care coverage is limited to medically necessary treatment for your eye problems. Some of the eye conditions covered by Part B may be a common and normal part of aging and are considered to be Medicare-covered services. MA plans include all Medicare-covered services plus some non-covered Medicare services, such as routine eye exams and financial allowances for corrective lenses.
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Why Was Medicare Plan F Discontinued
Why was Medigap Plan F discontinued? Per MACRA, first-dollar coverage plans will no longer be available to new beneficiaries. This is due to an effort by Congress to curb medical overspending and provide adequate wages for doctors. If you currently have Plan F or are not newly eligible, you can still enroll.
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A legal eye care provider is required in your state to perform the test. Seniors can shop around for a Medicare Advantage plan that offers vision coverage and speak with a plan representative about covered benefits.
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What Does Medicare Cover
Medicare covers the most common cataract surgery procedures that use conventional techniques or computer-controlled lasers to remove the cataract and insert an intraocular lens implant.
- Phacoemulsification In this, the most common technique, an ultrasonic device is inserted through a small incision in the cornea, which then breaks the lens into pieces that can be extracted with a suction device.
- Laser-assisted surgery is a newer method that modernizes the traditional manual process with a machine-controlled laser system.
Phacoemulsification and laser-assisted surgery are equally covered by Medicare. Your ophthalmologist can help you decide on the best method.
While Medicare covers the most common monofocal lens involved in cataract surgery, it doesnt cover all types of intraocular lenses. Other lenses, such as multifocal and toric lenses, are generally not covered.
Does Medicare Pay For Low Vision Devices
Currently, Medicare usually does not cover the cost of any device or aid that uses a lens, including low vision devices that help to maximize the remaining vision for someone who has experienced impaired vision. This is similar in nature to the fact that Medicare generally does not cover eyeglasses or contact lenses.
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Does Medigap Cover Eye Exams
As Medigap plans are used to supplement Original Medicare, it also does not provide any coverage on routine vision care.
Medigap will only cover costs for what Original Medicare covers so you may be able to receive coverage for diabetic retinopathy exams, glaucoma tests, and macular degeneration tests and treatments. Coverage will depend on the type of Medigap plan you have purchased.
Is An Ophthalmologist Covered By Medicare
As a specialist in eye and vision care, an ophthalmologist diagnoses and treats eye diseases, provides medical and surgical interventions, and prescribes and fits corrective lenses. Medicare will help pay for ophthalmologist services in cases of medical and surgical concerns related to the eyes. Original Medicare will not pay for routine eye exams or corrective lenses whether you receive them from an ophthalmologist or optometrist.
MA plans with vision benefits will help pay for in-network ophthalmologist services. You may be required to obtain a referral or prior authorization and may incur a specialist copay and/or coinsurance for exams or surgical procedures. Contact your plan, discuss your coverage with your vision care provider, or review the EOC or Summary of Benefits for details to determine your benefits and what you have to pay.
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Original Medicare And Cataract Surgery
In addition to covering some of the expenses associated with treating age-related macular degeneration, Medicare covers a specific set of costs related to cataract surgery conducted via traditional surgery or lasers because this is deemed a medically necessary procedure.
With a Medicare Advantage plan, you are entitled to all of the benefits covered under Original Medicare , but they are provided by private insurance companies instead.
Medicare Part B also assists by helping pay for corrective lenses required after cataract surgery in which an intraocular lens is implanted. These corrective lenseswhether eyeglasses or contactsmust be purchased from a Medicare-enrolled supplier in order to be covered either in whole or in part.
To determine what your portion of the expenses would be if you have Medicare Part B and need cataract surgery, Medicare.gov recommends checking with the doctor or medical care facility conducting the procedure. Theyll be able to give you a better estimate based on:
- How much care youll need post-surgery
- Whether the surgery will be conducted on an inpatient or outpatient basis
- Whether youve met your deductible
- If you have any copayments
- If you have any other additional insurance policy that may pick up some or all of the costs
What Is Medicare Supplement Plan G
Medicare Supplement Plan G, administered by Premera Blue Cross, allows the use of any Medicare contracted physician or hospital nationwide. The plan is designed to supplement your Medicare coverage by reducing your out-of-pocket expenses and providing additional benefits. It pays some Medicare deductibles and coinsurances, but primarily supplements only those services covered by Medicare.
You may choose to purchase a Medicare supplement Plan G from a private insurance company or enroll in the Premera Blue Cross Medicare Supplement Plan G that the PEBB Program offers, if eligible for PEBB retiree coverage.
In Medicare Supplement Plan G, benefits such as vision, hearing exams, and routine physical exams may have limited coverage or may not be covered at all.
If you select Medicare Supplement Plan G, any eligible family members who are not entitled to Medicare will be enrolled in UMP Classic.
Medicare Supplement Plan G does not include prescription drug coverage. If you select this plan, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable prescription drug coverage .
Medicare Part A Covers Emergency And Traumatic Vision Care
Under Part A of Medicare, you are covered for medically necessary vision care. The coverage applies to emergency room procedures and any eye conditions requiring hospitalization. Such as traumatic injury. Your Medicare Supplement vision coverage would pay according to your Medicare Supplement Benefits for Part A.
Does Medicare Cover Cataract Surgery
Cataracts cloud the lens of the eye, making it difficult to see. Surgery is generally needed to correct the condition, although mild cataracts might not require surgery. If your doctor only recommends corrective lenses without surgery, the same parameters described above would apply .
But assuming you need cataract surgery, Original Medicare will cover most of the cost. Cataract surgery is almost always an outpatient service, so its covered under Medicare Part B. That means you pay the Part B deductible and 20% of the rest of the Medicare-approved cost for the cataract surgery.
Additionally, Medicare Part B will pay for a pair of corrective eyeglasses or contacts that are necessary following cataract surgery, with you paying the normal 20% coinsurance that applies to all services covered under Part B.
Depending on your vision needs, you may be offered upgraded intraocular lenses that will correct your vision as well as eliminating the cataract. If you choose this option, you have to pay the additional cost yourself, but Medicare will still pay the amount it would have paid for you to have basic intraocular lenses inserted during the cataract surgery.
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When Might Medicare Cover Eye Exams
While Original Medicare doesnt generally cover routine eye care, there are a few instances when your Part B coverage may help offset your eye exam costs:
- If you are considered to be at high risk for glaucoma , Part B may cover 80% of allowable costs if your doctor believes the test is medically necessary.
- If you have diabetes, Part B may cover 80% of your eye exam cost to check for diabetic retinopathy.
- Certain people with age-related macular degeneration may qualify for Part B coverage of eye exams and treatment, including injectable medications, for the disease.
- If your eye gets injured, Original Medicare may cover medically necessary diagnostic eye exams and treatment.
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.
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How Do I Budget For Vision Care
Start by having a conversation with your physician or healthcare provider about the costs of testing, services, glasses or contact lenses and potential surgeries. Having a better understanding of cost will help you budget for these items. Another alternative is to consider a Medicare Advantage plan, many of which include coverage for routine vision care, like eye exams and eyeglasses.
This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional. You should consult your doctor to determine what is right for you.
Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Humana is also a Coordinated Care plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in any Humana plan depends on contract renewal.
Some links on this page may take you to Humana non-Medicare product or service pages or to a different website.
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Does Medicare Cover Routine Vision Services
Original Medicare wont pay for routine vision services like eye exams, prescription glasses, or contact lenses. But theres an exception to this if youve just had cataract surgery in that case, Medicare Part B will cover some of the cost of a single pair of glasses or set of contact lenses . And if you have a medical condition that requires custom eyeglasses or contact lenses, Medicare might pick up the tab.
On the other hand, Medicare Advantage generally covers standard vision testing, as well as glasses or contacts. If youre going to stick to original Medicare but want coverage for routine vision services, supplement insurance wont solve that problem Medigap wont pay for vision care or eyeglass benefits, either. But if you have maintained supplemental coverage from a current or former employer, that coverage might include vision benefits, so be sure you understand any benefits you might have before you pay full price for eye exams and corrective lenses.
Does Medicare Cover Laser Cataract Surgery
The short answer to this question is yes.
Medicare will cover your cataract surgery, regardless of the method used. So, whether the surgery is performed using a laser or a more traditional technique, the only thing that matters regarding your coverage is which procedures are performed. This means that if youre going to undergo a laser cataract surgery, you will still receive the same coverage.
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What Vision Services May Be Covered By An Aetna Medicare Plan
If you enroll in an Aetna Medicare Advantage plan that includes vision coverage, the plan may cover:
- Annual eye exams
The costs associated with vision benefits may be included as part of your plans premiums or as an Optional Supplemental Benefit, which means you would pay an additional premium.
If your plan covers vision, the benefits may be available to you as either an allowance or via a provider network.
A plan allowance allows you to see any licensed vision care provider. You pay the provider for their services and submit a receipt to your plan for reimbursement up to the allowance amount.
A plan network requires you to see a vision care provider who is a part of the plan network to receive covered services.
Aetna Medicare Advantage plans cover all of the benefits and services that are covered by Medicare Part A and Part B. Aetna Medicare Advantage plans may also provide additional benefits such as coverage for:
- Prescription drugs
1 Freed M, et al. A Dozen Facts About Medicare Advantage in 2020. . Kaiser Family Foundation. Retrieved from https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020.
2 According to internal data from TZ Insurance Solutions in 2020.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
Not all plans or products are available in all markets. Additional plans may be available in your service area.