The original form of the Medicare, Part A and Part B, are the foundation of standard Medicare benefits from the government. While broad hospitalization and medical benefits are included in Part A and Part B coverage, not every healthcare service is covered. Traditional vision coverage is not among the benefits of Medicare Parts A and B.
The absence of vision benefits within traditional Medicare coverage does not mean a Medicare enrollee cannot obtain some form of vision insurance coverage. HealthPocket’s research on 2014 Medicare Advantage plans found that nearly all Medicare Advantage plans in the U.S. (94%) included some form of vision benefits. Since vision benefits are not standardized, the details of these vision benefits varied among plans.
Another insurance option that seniors can investigate is a stand-alone vision plan. The phrase “stand-alone” is used to indicate that the vision coverage is not a rider within a larger insurance plan.
As mentioned earlier, traditional Medicare Parts A and B do not provide vision benefits in most cases. This means that regular eye exams related to eyeglass prescriptions, and the associated glasses or contacts, are not normally covered by Medicare. There are some exceptions such as for people who undergo cataract surgery and require corrective glasses or contacts related to an implanted intraocular lens.
However, insurance coverage for vision issues can be very important to the senior enrollees within the Medicare program. Over 150 million Americans of all ages utilize corrective eyewear (glasses, contacts, etc.). Seniors, in particular, may face a series of eye issues that are more prevalent among the aged:
Original Medicare does not pay for eyeglasses in most situations. However, there are medical circumstances (e.g. an eye injury) where Medicare will pay for a pair of glasses or contact lenses. The Centers for Medicare & Medicaid Services (CMS) states that for Medicare to pay for vision services, the services must satisfy three basic requirements:
When Medicare does pay for eyeglasses or contact lenses, the following conditions apply:
As mentioned earlier, Medicare enrollees seeking vision coverage have several options:
Before enrolling in any vision insurance, confirm the coverage details regarding:
Regular eye exams are recommended for seniors. Aside from documenting any changes in vision, eye exams can also detect other issues related to health. Medicare does not pay for routine eye exams related to glasses. However, Medicare does pay for eye exams related to:
The American Academy of Ophthalmology’s review of vision statistics indicate that by age 80 over half of Americans have at least one cataract. Cataracts are often treated by surgery. Medicare Part A does cover medically-necesary cataract surgery and related healthcare. The average cost (without insurance) for cataracts ranges from $3,000 to nearly $5,000. However, for Medicare beneficiaries there is a Medicare rate and normally the patient would pay the normal Medicare deductibles and co-payments. The specifics of these out-of-pocket costs partially depend on whether the procedure is performed as an in-patient or out-patient surgery.
Before enrolling in an insurance plan for the purpose of obtaining vision coverage, you should ask the following questions: