Do Aetna® Medicare Plans Cover Routine Vision Services?
If you’re enrolled in Original Medicare (Part A and Part B), you may not realize that most routine vision costs, such as eye exams and glasses, aren’t generally covered. However, some of Aetna’s Medicare Advantage plans may include vision benefits. Learn more about Aetna’s Medicare Advantage plans and how you can get help with routine vision costs.
Does Original Medicare offer vision coverage?
Original Medicare, Part A and Part B, offers limited routine vision coverage. There are a few exceptions: for example, Medicare may cover preventive eye exams in some cases if you have diabetes. Medicare may also help cover glasses or contact lenses after you’ve had cataract surgery to implant an intraocular lens.
However, Original Medicare generally does not cover routine vision services and items such as:
- Routine eye exams (or “eye refractions”)
- Fitting exams for contacts or glasses
- Eyeglasses lenses and frames
- Contact lenses
- Upgrades to eye ware
For these services and items, you’ll usually pay the full cost out of pocket under Original Medicare.
How Aetna’s Medicare Advantage plans may cover routine vision services
Some of Aetna’s Medicare Advantage plans may cover routine vision care. Medicare-approved private insurance companies like Aetna offer Medicare Advantage plans as another way to get your Original Medicare (Part A and Part B) coverage.
Medicare Advantage plans offer at least the same level of coverage you’d have under Original Medicare and may also cover extra benefits like prescription drugs, routine vision or dental services, or hearing services.
Typically, Aetna’s Medicare coverage for routine vision services works in either of two ways:
- Provider network: Aetna’s Medicare Advantage plans may require you to use a provider network for vision care. This means you must choose from your plan’s list of optometrists and vision providers. Some of Aetna’s Medicare plans (such as preferred provider organizations, called PPOs) may let you go out of network and pay higher copayments.
- Set allowance: Aetna’s Medicare plans might also give you a set limit for covered vision costs. You’ll typically pay upfront for vision services, submit itemized receipts to your plan, and be reimbursed up to the set amount. This type of plan offers provider flexibility: you can use any provider for vision care.
Aetna’s Medicare Advantage plans may include routine vision benefits, but coverage details may vary. Not every Aetna Medicare Advantage plan might include this coverage. If vision care is a benefit you’re interested in, check the Evidence of Coverage document for the plan you’re considering.
Costs for vision coverage in Aetna’s Medicare Advantage plans
If you’re enrolled in one of Aetna’s Medicare Advantage plans, it’s important to follow the rules of your plan to keep your costs down. Some of Aetna’s Medicare Advantage plans, such as health maintenance organizations (HMOs), may require you to use network providers to be covered, except in cases of emergency care, out-of-area dialysis or urgent care. Other types, such as PPO or HMO point-of-service plans, may let you go out of network for a higher cost.
When it comes to routine vision coverage, some of Aetna’s Medicare plans may wrap this coverage into the cost of the plan’s premium, while others may cover vision services as an “optional supplemental benefit” (meaning that you’ll pay a separate premium for this coverage). Again, costs and benefits vary for each of Aetna’s Medicare Advantage plans, so always check the details for your specific plan.
Please note that some of Aetna’s Medicare Advantage plans may have a monthly premium – while others might have a $0 premium. However, in either case, you’ll need to keep paying your Medicare Part B premium.
Browse Aetna’s Medicare plans with routine vision coverage
If you’re ready to browse Aetna’s Medicare Advantage plans and find coverage that may work for your needs, it’s simple to compare options. Just enter your ZIP code into the plan finder tool on this page to view Aetna’s Medicare plan options in your area.
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.
Out-of-network/non- contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call Aetna’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.