If you are a Medicare beneficiary in need of vision services, you may need to look further than Original Medicare for coverage. Typically, Original Medicare does not offer routine vision services as they are not deemed medically necessary by the Centers for Medicare & Medicaid Services (CMS), the governing body of Medicare.
There are some cases where Medicare may cover vision-related services. However, these instances are very specific. If you are seeking additional vision coverage, you have options.
Does Medicare Cover Vision Services?
Original Medicare coverage does not include coverage for routine vision care. Yet, it still may include coverage for critical eye conditions that affect vision.
Medicare coverage will pay for services and related costs for eye conditions like glaucoma, cataracts, and detached retinas. Medicare considers these services medically necessary.
However, if you require a routine eye exam, Lasik eye surgery, contact lenses, or glasses, you will not be covered under Medicare Part A or Medicare Part B. In these cases, you will need to enroll in additional vision coverage
On the other hand, if you require surgery for cataracts, glaucoma, or a detached retina that must be performed in an inpatient setting, Medicare Part A will cover the hospital costs.
Medicare Part B Vision Coverage
Medicare Part B does not cover routine vision services but will help with more severe conditions. If you require cataract removal, glaucoma care, surgery for detached retinas, or other critical eye care, Medicare Part B will pay 80% of your costs after you reach the Medicare Part B deductible.
For cataract or detached retina procedures, Medicare Part B will cover the services as well as one pair of eyeglasses following the surgery, if medically necessary. If you require glaucoma care, Medicare Part B will cover an annual preventive exam for high-risk individuals.
If you have a Medicare Supplement, it will often cover the 20% left behind by Medicare Part B. Still, it will not cover any additional services outside of what Medicare Part B covers. So, even though you have an additional form of coverage, you will still not get coverage for routine vision services. However, there are coverage options available to you.
Stand-alone dental plans are available for those with Medicare who seek additional benefits. These plans offer a range of vision coverage as well as additional benefits to help cover the gaps in Original Medicare. Often, vision plans pair with hearing and dental benefits as well to help round out your coverage. Many Medicare beneficiaries enroll in these plans to help save on out-of-pocket vision costs.
Medicare Part C Vision Coverage
Medicare Part C, or Medicare Advantage plans, often cover the costs of routine dental services. Keep in mind, though, that not every Medicare Advantage plan offers vision coverage.
Select Medicare Advantage plans allow beneficiaries to receive additional vision benefits to help cover the cost of routine vision exams, glasses, and contacts.
Vision benefits vary from plan to plan, so not every plan offers an equal level of coverage. It is important to know your plan’s maximum vision benefit and compare that to your annual vision needs. Your plan may require you to pay an additional premium for you to receive the highest level of vision coverage.
Medicare Part D Vision Coverage
Medicare Part D does not offer any vision benefits to Medicare beneficiaries. If you have a Medicare Part D prescription drug plan, it will only cover the costs of your prescription medications.
There are certain eye medications that Medicare Part D plans cover. Also, if your optometrist prescribes any medications in relation to eye conditions for pain, infection, or any other symptom, your Medicare Part D plan will cover that as well.
How to Know if my Vision Service is Covered
Knowing whether or not your vision service is covered by Original Medicare is important to understand before proceeding with the procedure or exam. The easiest way to know is by asking.
Speak with your doctor or your plan administrator to understand which services Medicare does and does not cover. This way, you will know if you should enroll in additional coverage.
