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Medicare Vision Benefits
Regular vision exams are important as you get older. But, you should know that routine Medicare vision benefits vary depending on the type plan you have and the type of vision care you receive. In some cases, vision care is not covered at all. It's a good idea to find out what kind of vision coverage you have before getting vision care.
Medicare Part A vision benefits
Medicare Part A is hospital insurance. Vision care is only covered under Medicare Part A when the vision condition is considered to be a medical problem. Conditions that affect vision are generally covered when it is a medical emergency or traumatic injury and the patient must be admitted to the hospital. Routine vision exams and eye refractions are not covered under Medicare Part A. Individuals must pay 100% of the cost unless they have other vision coverage.
Medicare Part B vision benefits
Medicare Part B is medical insurance. Some vision care is covered by Medicare Part B, but routine vision exams are not covered. You are not covered for vision correction such as eyeglasses or contact lenses under Medicare Part B unless you need vision correction after cataract surgery. Medicare Part B also does not cover eye refractions.
Yearly glaucoma screenings are covered by Medicare Part B for people who are at high risk. High-risk patients include those with a family history of glaucoma, African-Americans age 50 and older and people with diabetes. State-approved vision care specialists are the only providers that may perform yearly vision screenings for glaucoma. You pay the 20% Medicare coinsurance for the vision care costs approved by Medicare, subject to your annual Medicare deductible.
Medicare Part B vision benefit covers cataract surgery. Medicare also covers the cost of the artificial lens you need to replace the lens that was clouding your vision. Medicare will also cover the cost for vision correction products such as glasses with standard frames following cataract surgery. You pay the 20% Medicare coinsurance for the amount approved by Medicare, subject to your annual Medicare deductible.
Eye prostheses are covered under Medicare Part B vision benefits for patients with absence or shrinkage of eye due to birth defect, trauma or surgical removal. Polishing and resurfacing of vision prostheses is covered twice per year under the vision benefits. One enlargement or reduction in size of prostheses is covered without documentation, but additional enlargements or reductions are only covered when medically necessary. Medicare will cover the cost for vision prosthesis replacement if the vision prosthesis is lost, stolen or irreparably damaged within the first five years.
Medicare Part B covers ocular photodynamic therapy with verteporfin, which is a treatment for patients with macular degeneration, a vision problem associated with age.
Medicare Part C vision benefits
Medicare Part C (or Medicare Advantage) plans are offered by private insurers. All private insurers must offer at least the same or similar benefits as Original Medicare, but they may include other benefits, such as routine vision, routine dental and Medicare prescription drug coverage. When routine vision benefits are offered by a Medicare Part C plan, you may pay a higher premium than Medicare Advantage plans that do not offer routine vision benefits.
Some of these plans include full coverage for routine vision exams, vision correction products, and other vision care. Review the specific plan's vision benefits to be sure.
Medigap routine vision benefits
Medigap plans do not include routine vision benefits.
Medicare Part D vision benefits
Medicare Part D offers prescription drug coverage, and it must be purchased as an addition to Medicare Part A and Medicare Part B (or Original Medicare). The prescription drug plan does cover certain products related to vision care, like eye drops or other vision medications that are prescribed by a doctor.
Medicare has neither reviewed nor endorsed this information.