Tuesday, May 21, 2024

Will Medicare Pay For Glasses

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Other Options For Routine Vision Care

Medicare must cover dental care, hearing aids, and eyeglasses.

If you enroll in Original Medicare or a Medicare Advantage plan without vision care benefits, you may still be able to get eye exam coverage. Many large insurance companies sell stand-alone vision, dental, and hearing policies you can combine with your Medicare coverage. If you buy a Medicare Advantage or Medicare Supplement plan, ask your insurer if they offer a separate vision care plan.

If you have a health savings account , you can take qualified withdrawals to pay for eye exams and glasses. If youre age 65 or over, you can even pay your vision insurance premium with HSA funds.

Even though Medicare vision coverage is limited, you still have options to help pay for eye exams and glasses. Compare Medicare Advantage plans in your area and check the costs of stand-alone vision plans. With so many options, youll certainly be able to find the right coverage to suit your individual health goals and financial needs.

Does Medicaid Cover Contact Lenses

Many people think that if Medicaid covers glasses, it will pay for contact lenses as well, but this is not necessarily the case. Contact lenses are not usually covered by Medicaid, but if they are deemed medically essential, they may be.

This need is determined by your local regulations, but for example, if you just underwent cataract surgery.

Eye Doctors That Accept Medicare

If youre looking for an eye doctor that accepts Medicare, visit Medicares official website and click on the Find Care Providers link and use the lookup tool to search for keywords, providers, specialty, and location.

If youre looking to check whether your Medicare covers certain medically necessary procedures or exams, the best place to check is with Medicare and your provider or corresponding Medicare plan. Some important factors to keep in mind include out-of-pocket costs, deductibles, and other additional costs that are not covered by Medicare.

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Medicare Advantage Plans: Additional Coverage

Fortunately, most Medicare Advantage plans do compensate for the lack of Original Medicare coverage in this area. In addition to vision-related procedures, most Medicare Advantage plans cover hearing and dental services as well.

To get a higher level of vision coverage than is offered through Original Medicare, you need to sign up for a Medicare Advantage plan with a private insurance provider. With a Medicare Advantage plan, you might have to pay a copayment or coinsurance cost for routine eye exams by in-network eye doctors. Most Medicare Advantage plans cover prescription glasses and contact lenses.

For more expansive coverage, you can also add a Medicare Part D prescription drug plan to your Medicare Advantage coverage. This may help cover the cost of certain medications and/or eye drops used to treat vision problems.

While private Medicare insurance carriers are required by law to provide at least the same base level of coverage offered by Medicare Part A and Part B, not all offer vision coverage as additional benefits. For this reason, it is important to be sure you read through your plan carefully to ensure you have the vision coverage you need.

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Eye Exams For Individuals With Glaucoma And Diabetes

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If youre at risk for glaucoma or diabetes, Medicare Part B can cover annual eye exams once every 12 months. For instance, if you use Medicare Part B for glaucoma eye exams, 80 percent of the exam will be covered. However, youd still be responsible for paying the remaining 20 percent of the Medicare-approved amount after youve met your Part B deductible.

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Vision Coverage Through Medicare Advantage

All Medicare Advantage plans must cover everything Medicare Part A and Part B covers as a bare minimum. But most Medicare Advantage plans also offer vision coverage.

However, since vision is considered additional coverage, you will have to pay extra for it.

Medicare Advantage plans may cover all or part of the costs of routine eye exams, glasses, contacts and any fittings for frames and lenses.

But you should shop around and look closely at exactly what a plan offers if youre interested in vision coverage. Not all plans include vision care.

Remember that Medicare Advantage plans are offered by private insurance companies and coverage differs from plan to plan and depending on the state where you live.

How Does Medicare Part B Cover Prescription Glasses

As with most covered services, Medicare Part B pays 80 percent of the cost of prescription lenses after cataract surgery to implant an intraocular lens. This includes either one pair of eyeglasses with standard frames or a single set of contact lenses. Additional guidelines include:

  • The Medicare Part B deductible applies
  • The supplier who provides your glasses or contacts must be enrolled in Medicare
  • You pay any additional costs if you choose to upgrade the standard frames

Medicare Part B will also cover cataract surgery when performed using either lasers or traditional techniques. Again, you pay 20 percent of the Medicare-approved amount and your healthcare provider must accept assignment.

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Finding A Medicare Advantage Plan That Covers Eyeglasses

Medicare beneficiaries who wear corrective lenses or have other vision care needs may want to consider enrolling in a Medicare Advantage plan.

Medicare Advantage plans offer the same benefits that are covered by Medicare Part A and Part B combined into a single plan sold by a private insurance company. Many Medicare Advantage plans may offer additional benefits such as prescription drug coverage, dental, hearing and more.

Some Medicare Advantage beneficiaries may cover annual eye exams and eyeglasses, sometimes with no deductible or with $0 monthly premiums. Plans with $0 deductibles and $0 premiums may not be available in all locations.

To compare Medicare Advantage plans in your area that may cover eyeglasses, call to speak with a licensed insurance agent today.

Or call 24/7 to speak with a licensed insurance agent.

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

Medicare has neither reviewed nor endorsed this information.

Does Medicare Cover Eye Prostheses

Medicare Explained: Does Medicare Cover Cataract Surgery and Glasses?

Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defect, trauma or surgical removal. Medicare covers polishing and of the artificial eye, and typically covers replacement every five years.

You pay 20% of Medicare-approved amounts after the Part B deductible is applied.

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Medicare Advantage Plans May Cover Prescription Sunglasses

Medicare Advantage plans may offer vision coverage including eyeglasses, contact lenses and prescription sunglasses. It may also include vision benefits such as coverage for routine eye exams. Each plan will be different, and youll need to talk with the provider about which eye health items are offered within a plan and how costs are covered.

Eye Glasses & Contact Lenses

How Do I Qualify For Eyeglasses or Contact Lenses After Cataract Surgery with Medicare Health Insurance?

  • Normally, Medicare health insurance doesnt cover eyeglasses or contact lenses. However, following cataract surgery with an intraocular lens, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses provided by an ophthalmologist. Services provided by an optometrist may be covered if the optometrist is licensed to provide this service in your state. Important Note:
  • Only standard frames are covered.
  • Lenses are covered even if you had the surgery before you had Medicare.
  • Payment may be made for lenses for both eyes even though cataract surgery involved only one eye.

There are several provisions regarding coverage.

What Will Eyeglasses or Contact Lenses Cost Me if I just had Cataract Surgery?

How much you pay will depend on what type of coverage you have and where you buy your glasses or contacts. These items are covered under Medicare Part B. However, in general, if you are enrolled in Medicare:

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Dont Rush Through Abn Completion:

Prepare to set aside time to talk with the patient about this form and its contents. As a supplier, youre responsible for carefully reviewing what insurance wont pay with the patient ahead of time. You must also answer all of the patients questions, before the patient signs, says CMS in its ABN form instructions. Most practices place a high premium on efficiency, but when it comes to the ABN, this can have unintended consequences. Providers try to breeze through it as fast as possible, not taking enough time to answer patients questions, says Holt.

You must deliver the form far enough in advance so that the beneficiary has time to consider the options and make an informed choice, according to CMS. The advance preparation part of the ABN process is the key challenge for most practices, says Rhonda Buckholtz, CPC, CPCI, CPMA, CDEO, CRC, CHPSE, COPC, CENTC, CPEDC, CGSC, vice president of strategic development for Eye Care Leaders. The beneficiary needs to have adequate notice prior to performing the service and must know Medicare may not cover it. The beneficiary must also be informed the reason why and how much it will cost, she continues.

Resource: For more on ABNs and CMS-R-131 form, visit .

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What Vision Benefits Does Part A Cover

Glasses, Contacts, and Eye Exams: Does Medicare Cover It?

Medicare Part A covers hospitalizations or inpatient care. If you need eye surgery that cannot be done in an office or clinic, Part A covers your hospital stay after you pay the deductible, which is $1,556 in 2022.11 For a hospital stay of fewer than 60 days, you would not pay any additional copayment or coinsurance.12

Also Check: How To Disenroll From A Medicare Advantage Plan

What Vision Benefits Does Medicare Part D Cover

You may need medications for an eye infection, allergies, or conditions like glaucoma or macular degeneration, or to diagnose and prevent eye diseases.

Eye medications often require a prescription. Some like artificial tears, eye drops, and ointments may be available over-the-counter, though youll need a prescription for Medicare to cover it.23

Medicare Part D covers medications via stand-alone Part D plans or MA plans.24 In 2019, 45 million people had opted for Part D coverage in 2019 almost half were in prescription drug plans .25Costs, policies, and covered medications vary widely depending on the plan.26

When Does Medicare Cover Glaucoma Screenings

Medicare Part B medical insurance covers glaucoma tests once every 12 months if you meet Medicares definition of being at high risk for developing glaucoma.

People at High Risk for Glaucoma

  • African-Americans age 50 or older
  • Hispanics age 65 or older
  • People who have been diagnosed with diabetes
  • People who have a family history of glaucoma

Medicare will not cover a glaucoma test unless the screening is done by an eye doctor who is legally permitted by the state where its done to conduct a glaucoma test or supervise it.

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Does Medicare Part D Pay For Prescription Lenses

Medicare Part D provides prescription drug coverage, which is not included with Original Medicare. And although prescription lenses are prescribed by an eye doctor , they are not covered by Medicare Part D.

You can compare your Medicare Part D and Advantage plan options with our Find a Plan tool. Just enter your location and coverage start date to review Medicare plans in your area.

Original Medicare: Minimal Coverage

Medicare Coverage Helpline TV Commercial: ‘Dental, Eyeglasses, & Prescriptions’

Original Medicare does not cover eye exams, eyeglasses, or contacts. Under an Original Medicare plan, you would have to pay for all of the associated costs related to these services.

However, there are a few exceptions. Medicare Part B does pay for some routine diagnostic tests and treatment for patients with certain risks or eye conditions, such as:

  • Annual eye exams for diabetes patients: The patient pays 20% of the Medicare-approved cost of the treatment or service.
  • Annual glaucoma tests for at-risk populations: The patient pays 20% of the cost.
  • Age-related macular degeneration tests and treatment: The patient pays 20% of the cost.
  • Corrective lenses for post-cataract surgery implant and intraocular lenses: The patient pays 20% of the cost issued from a Medicare-enrolled supplier.

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Does Medicare Cover Eye Exams 2022 Medicare Vision Coverage

While it doesnt offer the comprehensive coverage of vision insurance, Medicare can provide coverage for medically necessary vision care, often for patients with certain health conditions like diabetes or glaucoma.

In this article, Ill discuss what type of eye exams Medicare covers, cataract surgery coverage, and how to find eye doctors that accept Medicare.

FYI: Often, vision coverage is pretty affordable. Read my picks for dental and vision insurance for seniors to learn more.

One Eye Exam Medicare Never Covers

Original Medicare doesnt cover routine eye exams, or any type of exam related to prescribing, fitting, or changing eyeglasses. This means youll be responsible to pay for your yearly doctor visit to check your eyes and update your prescription. Medicare never pays for vision exams , even after cataract surgery.

Although Original Medicare doesnt provide vision coverage, it doesnt mean youll automatically have to pay out of pocket for eye exams and glasses or contacts. That depends on what other types of coverage you have, if any.

  • If you have a Medicare Supplement plan, youll still have to pay out of pocket for routine eye exams. This is because Medicare Supplement plans are designed to help you cover the costs of Original Medicare, not add coverage for items or services Original Medicare doesnt cover.
  • If you have a Medicare Advantage plan, you may have vision coverage. Some plans provide coverage for a yearly exam, plus an allowable dollar amount to put toward glasses or contacts. Check with your specific plan to see what your specific coverage entails.

Read Also: Who Pays For Part A Medicare

Hearing Exams And Hearing Aids

Medicare doesnât cover routine hearing exams, hearing aids, or exams for fitting hearing aids. Medicare Part B covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment. All people with Part B are covered.

Your costs in Original Medicare:

  • You pay 100% for routine exams and hearing aids.
  • You pay 20% of the Medicare-approved amount for the doctorâs services for covered exams, and the Part B deductible applies.
  • In a hospital outpatient setting, you also pay the hospital a copayment.

Note: Some Medicare Advantage plans offer extra hearing benefits. Be sure to contact the plan for more information.

Does Medicare Cover Eyeglasses Or Contact Lenses

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Original Medicare does not cover eyeglasses or contact lenses without a stand-alone vision plan or Medicare Advantage, you pay 100% of the costs.8

Cataract surgery

Cataract surgery treats a condition that makes the lens in your eye cloudy and can affect your vision. If you have cataract surgery, Part B will pay for your eyeglasses or contact lenses following that surgery.

Part B will only pay for specific frames9 from a Medicare-approved provider.10 You pay more if you choose upgraded frames.

Read Also: Why Do I Need Medicare Part B

Do Medicare Advantage Plans Cover Eyeglasses

You may have other options as a Medicare beneficiary if youd like help covering the cost of eyeglasses. Medicare Advantage, also called Medicare Part C, is required by law to cover everything that Original Medicare covers, except hospice care, which is still covered under Part A. The main difference is that instead of getting your Part A and Part B benefits through the federal program, your coverage is administered through your Medicare Advantage plan, which is available through Medicare-contracted private insurance companies. Your costs may also be different than Original Medicare.

In addition, many Medicare Advantage plans offer additional benefits, including routine vision or dental, hearing services, or wellness programs. In many cases, you may be able to find a plan in your area that pays all or part of the costs associated with prescription eyeglasses, contact lenses, annual exams, or fittings. You may have to pay a deductible before your Part C benefits apply, depending on the plan. Not every Medicare Advantage plan includes vision benefits, so if youre interested in finding a plan with vision coverage, check with the specific plan before enrolling.

Does Medicare Pay For Glasses Or Contacts

Medicare doesnt typically cover the cost for eyeglasses or contact lenses, and youll normally have to pay the full cost for these items, as well as exams to get fitted for them. However, if you get cataract surgery to insert an intraocular lens, Medicare Part B covers corrective lenses following your surgery. Youre covered for either one pair of glasses or contact lenses if you get these items through a supplier that is enrolled in the Medicare program.

All beneficiaries with Medicare Part B are covered, and youll pay 20% of the Medicare-approved cost for the eyeglasses or contact lenses . If you decide to upgrade your frames, youll pay for any extra costs.

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