Medicare Part B Coverage
Medicare Part B will pay for corrective eyeglass lenses after youve had cataract surgery with an intraocular lens implant.
However, this doesnt mean your glasses are completely free. You will pay 20 percent of the cost for your eyeglasses, and your Part B deductible applies. A couple of stipulations include:
- youll pay additional costs for upgraded frames
- you must purchase the eyeglasses from a Medicare-enrolled supplier
If you lose or break these glasses, Medicare wont pay for new ones. Medicare only pays for one new pair of eyeglasses per lifetime, per eye you have surgery on. So, if you have surgery to correct one eye, you can get a pair of eyeglasses at that time. If you have cataract surgery on another eye at a later time, you can get another new pair of eyeglasses.
Other Coverage Options For Eyeglasses
There are several organizations that can help with the costs of your eyeglasses and vision care. Some examples include:
- EyeCare America. This is a service from the American Academy of Ophthalmology that partners with area volunteer eye doctors to provide eye exams. However, this organization doesnt provide eyeglasses.
- Lenscrafters Foundation: OneSight. This foundation has provided more than 10 million eyeglasses to those in need since its founding.
- Lions Club International. This nonprofit organization provides free eyeglasses to those in its member communities. Contact your local Lions Club chapter to find out more.
- Medicaid. Medicaid is a state-based government program that helps pay for healthcare and other services for those in need. While Medicaid coverage may vary state by state, many programs pay for a pair of eyeglasses and lenses once every 5 years.
- New Eyes for the Needy. This is another nonprofit program that helps provide eyeglasses for those in need. Visit its website to see if you may qualify.
When Does Medicare Pay For Eye Exams And Glasses
Original Medicare doesnt cover routine eye exams and prescription eyewear. This means if you have Part A and Part B, you generally pay 100 percent of the costs associated with annual eye exams, glasses, and contact lenses.
Medicare will pay for eye exams in certain situations. For example, Medicare pays for eye health screening and diagnostic exams if you have diabetes or age-related macular generation or you are at high risk for glaucoma.
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How Does Medicare Cover Vision Services And Treatment
Medicare wont pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions.
Q: How does Medicare cover vision services and treatment?
A: Original Medicare wont pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions. Most Medicare Advantage plans do include coverage for routine vision services like eye exams and glasses or contacts. They will also cover treatment for eye diseases and conditions, although the out-of-pocket costs can vary considerably depending on the specific plan.
This FAQ addresses the specifics of Original Medicare coverage, since its the same for all beneficiaries. But its also important to note that supplemental coverage provided by Medigap, Medicaid, or an employer-sponsored plan can result in two Original Medicare beneficiaries having very different out-of-pocket costs when all is said and done.
Original Medicare And Cataract Surgery
In addition to covering some of the expenses associated with treating age-related macular degeneration, Medicare covers a specific set of costs related to cataract surgery conducted via traditional surgery or lasers because this is deemed a medically necessary procedure.
Medicare Part B also assists by helping pay for corrective lenses required after cataract surgery in which an intraocular lens is implanted. These corrective lenseswhether eyeglasses or contactsmust be purchased from a Medicare-enrolled supplier in order to be covered either in whole or in part.
To determine what your portion of the expenses would be if you have Medicare Part B and need cataract surgery, Medicare.gov recommends checking with the doctor or medical care facility conducting the procedure. Theyll be able to give you a better estimate based on:
- How much care youll need post-surgery
- Whether the surgery will be conducted on an inpatient or outpatient basis
- Whether youve met your deductible
- If you have any copayments
- If you have any other additional insurance policy that may pick up some or all of the costs
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Does Medicare Pay For Eye Exams
Medicare does not cover routine eye exams unless you have diabetes, glaucoma or macular degeneration. Read our guide to find out what options you have as you look for coverage for eye coverage.
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Original Medicare does not pay for routine eye exams, eyeglasses or contact lenses.
There may be special exceptions if you have diabetes, glaucoma, or macular degeneration.
A Medicare Advantage plan may offer additional coverage that could include routine eye exams, eye glasses or contact lenses.
Original Medicare does not pay for routine eye exams, except in special circumstances. You will be responsible for the entire cost of those services out of pocket. There are ways, however, to get the vision health coverage you need. We’ll tell you how to do it.
What Is The Medicare Coverage For Eye Care And Eyeglasses
Contributing expert: Kelly Blackwell, Certified Senior Advisor®Medicare Part B covers medically necessary exams and treatments for diseases and injuries of the eyes. Original Medicare does not cover routine vision exams or corrective lenses, but most Medicare Advantage plans do offer some vision benefits, in addition to all Part B services and treatments.Updated: December 07, 2021
Kelly Blackwell is a Certified Senior Advisor ®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
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Does Medicare Cover Vision And Glasses
Original Medicare does not cover routine vision exams or glasses, but Part B helps cover certain vision-related services if you have eye disease or injury. Medicare Advantage plans, an alternative to Original Medicare, provide the same coverage as Part B, plus more. Most MA plans offer some coverage for routine eye exams and corrective lenses.
Part B vision care coverage is limited to medically necessary treatment for your eye problems. Some of the eye conditions covered by Part B may be a common and normal part of aging and are considered to be Medicare-covered services. MA plans include all Medicare-covered services plus some non-covered Medicare services, such as routine eye exams and financial allowances for corrective lenses.
Does Medicare Cover Treatment Of Macular Degeneration
Medicare Part B will cover certain diagnostic tests and treatment of diseases and conditions of the eye, which include treatment with certain injected drugs. Some people with age-related macular degeneration are covered by Medicare. You would be responsible for 20% of Medicare-approved amounts for diagnosis and treatment of diseases and conditions of the eye after the Part B deductible is applied.
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Is An Ophthalmologist Covered By Medicare
An ophthalmologist, as a specialist in eye and vision care, diagnoses and treats eye diseases, provides medical and surgical interventions and also prescribes and fits corrective lenses. Medicare will help pay for ophthalmologist services in cases of medical and surgical concerns related to the eyes. Original Medicare will not pay for routine eye exams or corrective lenses whether you receive them from an ophthalmologist or optometrist.
MA plans with vision benefits will help pay for in-network ophthalmologist services. You may be required to obtain a referral or prior authorization and may incur a specialist copay and/or coinsurance for exams or surgical procedures. Contact your plan, discuss your coverage with your vision care provider, or review the EOC for details to find out what your benefits are and what you have to pay.
Do Medicare Advantage Plans Cover Eyeglasses
You may have other options as a Medicare beneficiary if youd like help covering the cost of eyeglasses. Medicare Advantage, also called Medicare Part C, is required by law to cover everything that Original Medicare covers, except hospice care, which is still covered under Part A. The main difference is that instead of getting your Part A and Part B benefits through the federal program, your coverage is administered through your Medicare Advantage plan, which is available through Medicare-contracted private insurance companies. Your costs may also be different than Original Medicare.
In addition, many Medicare Advantage plans offer additional benefits, including routine vision or dental, hearing services, or wellness programs. In many cases, you may be able to find a plan in your area that pays all or part of the costs associated with prescription eyeglasses, contact lenses, annual exams, or fittings. You may have to pay a deductible before your Part C benefits apply, depending on the plan. Not every Medicare Advantage plan includes vision benefits, so if youre interested in finding a plan with vision coverage, check with the specific plan before enrolling.
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Does Medicare Pay For Glasses And Eye Exams
Generally speaking, Medicare does not cover routine eye exams, eyeglasses or contact lenses. If you have an Original Medicare plan , you will be required to pay 100% out of pocket for these vision costs.
However, Part B may help to cover the cost of an exam and other vision costs if you have certain eye health conditions. But you still need to do your homework before scheduling any exams or procedures.
For instance, if you have had cataract surgery to implant an intraocular lens and youre hoping Part B will help cover the cost of corrective lenses post surgery, keep the following in mind:
Your supplier must be enrolled in Medicare.
You must meet your Part B deductible.
Medicare covers one pair of glasses OR one set of contact lenses per cataract surgery.
Any added costs for upgraded frames would be paid for out of pocket.
You will be required to pay 20% of the Medicare-approved amount for corrective lenses after each cataract surgery.
If you want more coverage, Medicare Advantage Plans offer added benefits, including routine vision costs like exams and eyeglasses.
A Guide To Medicare Vision Coverage
Everyone 60 years of age and older should have an eye exam every single year, according to the American Optometric Association . This is extremely important for this particular segment of the population because the AOA says many conditions affecting older adults tend to have no early warning signs whatsoever.
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Eyeglasses And Contact Lenses
Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses .
Note: Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim .
All people with Part B are covered. Your costs in Original Medicare are:
- You pay 20% of the Medicare-approved amount for one pair of eyeglasses or one set of contact lenses after each cataract surgery with an intraocular lens.
- Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter who submits the claim .
- You pay any additional costs for upgraded frames.
- You pay 100% for non-covered services, including most eyeglasses or contact lenses. The Part B deductible applies.
Note: Some Medicare Advantage plans offer extra vision benefits. Be sure to contact the plan for more information.
Medicare Advantage And Vision Coverage
If you want a Medicare-based plan that offers vision coverage, Medicare Advantage is one option to consider.
With a Medicare Advantage plan, you are entitled to all of the benefits covered under Original Medicare , but they are provided by private insurance companies instead.
This allows you to choose a policy that offers vision coverage in addition to the typical Medicare coverages. You may pay a bit more for it, but it may be cheaper than paying your own expenses toward exams, eyeglasses, and contacts on an annual basis.
Do not confuse Medicare Advantage with Medigap insurance. Medigap doesnt typically offer vision care or eyeglass benefits, but it can be used to help cover costs associated with copayments, coinsurance, and deductibles.
Medicare vision coverage is limited, but it does provide benefits in some cases. Its important to always check with your individual plan to know for sure what your policy will pay and what amount youll be responsible for.
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Does Medicare Pay For Glasses
Post-cataract services provided by an optometrist may be covered, if the optometrist is licensed to provide this service in your state, and:
- Medicare will pay only for standard frames.
- Eyeglasses and contact lenses are covered even if you had the surgery before you had Medicare.
- Both eye lenses may be covered even if you had your cataract surgery on one eye only.
A prescription order signed by your doctor must be on file with the supplier. Suppliers must be enrolled in Medicare and must meet strict standards to qualify for a Medicare supplier number. Medicare wont pay your claim if your supplier doesnt have a number, even if your supplier is a large chain or department store that sells more than just durable medical equipment .
After each cataract surgery with an intraocular lens, you pay 20% of Medicare-approved amounts for one pair of eyeglasses or one set of contact lenses, after the Part B deductible, if applicable.
Medicare will only reimburse or pay for the standard eyeglass frame amount. You pay an additional cost for upgraded frames.
For more information about Medicare eye care, you may call 1-800-MEDICARE , 24 hours a day, seven days a week.
Note: Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment. If the supplier is a participating supplier, it must accept assignment. If the supplier is enrolled in Medicare but isnt participating, it has the option to accept assignment.
Does Medicare Cover Eye Exams For Cataracts
Medicare typically pays allowable charges related to diagnosis and treatment of cataracts, including cataract surgery. Youre responsible for the Part A deductible if your surgery requires a hospital stay, and your Part B deductible, plus your 20% coinsurance for covered outpatient services.
If you have cataract surgery with an intraocular lens implant, Part B usually pays for one pair of prescription eyeglasses or contact lenses after your surgery.
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Does Medicare Cover Glaucoma Screening
Medicare Part B covers a glaucoma screening test once every 12 months for people at high risk for glaucoma. This includes people with diabetes, a family history of glaucoma, African Americans who are age 50 or older, and Hispanic Americans who are age 65 or older. The screening must be done or supervised by an eye doctor who is legally allowed to do this service in your state.
You pay 20% of Medicare-approved amounts, and the Part B deductible applies.
Does Medicare Cover The Cost Of Glasses
Does Medicare pay for glasses?
Access to vision benefits varies based on the Medicare plan you have, and in some cases, eye exams and new glasses may not be covered at all.
So, if you have Medicare, before you schedule your next visit to the eye doctor, lets review the routine vision benefits that are covered, and what you will have to pay out of pocket for an updated pair of glasses.
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How Can You Get Your Routine Eye Exams Paid For By Medicare
If none of the special circumstances above apply to you, don’t give up yet. It’s still possible for you to obtain Medicare coverage that will pay for routine vision care.
A Medicare Advantage plan is an alternative way of getting your Medicare benefits. These are healthcare plans that are offered by Medicare-approved private companies, and they take the place of Medicare A and B if you choose to enroll in one of them.
Medicare Advantage plans offer a variety of additional benefits that are not covered under Original Medicare. Vision, dental, wellness and hearing services are offered in many of these plans.
Extra items such as adult daycare services, transportation to medical visits, and over-the-counter medications also may be included. Medicare Part D, which covers prescription medication, is also usually incorporated into these plans.
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Unlike Original Medicare, which is accepted almost everywhere, Medical Advantage plans usually have a local network of preferred providers. Like many employer health plans, they may not cover services that are out of network, or they may cover a smaller portion of out-of-network services. They may also have certain rules for referrals and other services, so be sure you understand what is required of you under the plan.
Original Medicare Coverage And Vision Testing
Original Medicare in general does not cover regular eye exams necessary for getting new or updated eyeglasses or contact lenses, according to Medicare.gov.
So, if you were to make an appointment strictly because you currently wear glasses or contacts and you notice that your vision is getting worselikely signifying that you need a new prescriptionthe exam would not be paid for by Medicare.
However, Medicare Part B will pick up some vision testing expenses in certain circumstances.
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