Medicare Vision Benefits
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Regular vision exams are important as you get older. But routine Medicare vision benefits vary depending on the type of plan you have. 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. Medicare Part A covers vision care only when the vision condition is considered a medical problem — as in a medical emergency or traumatic injury when the beneficiary must be admitted to the hospital. Medicare Part A does not cover routine vision exams and eye refractions. Beneficiaries must pay 100% of the cost unless they have other vision coverage.
Medicare Part B vision benefits
Medicare Part B is medical insurance. Medicare Part B covers some vision care, but not routine vision exams. 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.
Medicare Part B covers yearly glaucoma screenings for people who are at high risk. High-risk patients include those with a family history of glaucoma, African Americans age 50 and older, Hispanic Americans age 65 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 benefits cover cataract surgery. Medicare covers the cost of the artificial lens you would need to replace the lens that affected by cataracts, as well as 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.
Medicare Part B vision benefits cover eye prostheses for patients with absence or shrinkage of the eye due to birth defect, trauma, or surgical removal. Medicare Part B also covers the polishing and resurfacing of vision prostheses twice per year under its vision benefits, as well as one enlargement or reduction in size of prostheses without documentation. Additional enlargements or reductions are only covered when medically necessary. Medicare covers 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) offers an alternative way to receive your Original Medicare benefits. Medicare Advantage plans are offered by private, Medicare-approved insurers. All private insurers must offer at least the same benefits as Original Medicare (except hospice care, which Medicare Part A covers), but they may include other benefits, such as routine vision, routine dental, and Medicare prescription drug coverage. When routine vision benefits are available through a Medicare Advantage plan, your premiums could be higher than those charged by Medicare Advantage plans that do not offer routine vision benefits.
Some Medicare Advantage plans include full coverage for routine vision exams, vision correction products, and other vision care. Review the specific Medicare Advantage 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, which you can sign up for to work alongside your Medicare Part A and Medicare Part B (Original Medicare) coverage. Medicare Part D Prescription Drug Plans are available from private, Medicare-approved insurance companies. A Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan may cover certain products related to vision care, like eye drops or other vision medications prescribed by a doctor.