Do you wear glasses? You’ll want to see this

According to the Vision Council of America, approximately 75% of adults use some sort of vision correction.1 Whether it’s eyeglasses, contacts or “cheater readers,” that’s a pretty big number.

Given that number, you may be surprised to learn that, unlike most Medicare Advantage plans, Original Medicare does not cover routine vision care.

It does, however, cover medically necessary treatments that may improve or cure chronic eye conditions like glaucoma or cataracts. But you'll need to check with your doctor to see if your condition makes the cut. For example, Lasik surgery for vision correction is not considered a medical necessity, so it’s not covered by Medicare.

Does Medicare cover eye exams?

A simple vision test is included in the “Welcome to Medicare” preventive visit. It’s covered by Medicare Part B, but it’s offered only once and within the first year of Part B coverage.

Routine eye exams for eyeglasses or contact lenses are not covered. However, a yearly eye exam is covered by Medicare Part B for those living with diabetes and diabetic retinopathy. Eye exams for diagnostic purposes, such as testing for glaucoma or macular degeneration, may also be covered.

You will have to pay 20% of the amount approved by Medicare for these services. Your Part B deductible will also apply. A copay will be charged if you get tested in a hospital outpatient setting.

Does Medicare cover eyeglasses?

The simple answer is no: Medicare usually does not cover the cost of eyeglasses or contact lenses. However, if you need cataract surgery—during which an intraocular lens (IOL) is implanted—Medicare Part B will help cover the cost of one set of corrective lenses (either contacts or glasses).

Does Medicare cover the cost of cataract surgery?

Medicare does cover cataract surgery as a medically necessary surgery. You can work with your doctor and the hospital or facility where you’ll have the surgery to help estimate the costs. You’ll also want to determine whether the surgery will be inpatient or outpatient.

This will impact what you pay. You can also sign in to MyMedicare.gov, opens new window to check if you’ve met your deductible, which must happen before Medicare will start to pay.

How do I budget for vision care?

Start by having a conversation with your physician or healthcare provider about the costs of testing, services, glasses or contact lenses and potential surgeries. Having a better understanding of cost will help you budget for these items. Another alternative is to consider a Medicare Advantage plan, many of which include coverage for routine vision.

Source

  1. “US Optical Overview and Outlook December 2015,” The Vision Council, last accessed May 9, 2019, thevisioncouncil.org/sites/default/files/Q415-Topline-Overview-Presentation-Stats-with-Notes-FINAL.PDF, PDF opens new window.

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