If you're enrolling in Medicare or already on it, it's plain to see that Medicare doesn't have the best coverage for eyeglasses. But there are ways to get your vision care covered.
Traditional Medicare, which is run by the federal government, generally does not pay for routine eye exams, eyeglasses or contact lenses, according to Medicare.gov. Traditional Medicare does, however, provide coverage for diagnosis and treatment of certain conditions of the eye.
And Medigap plans, which are supplemental plans designed to cover the gaps in traditional Medicare, do not cover vision care, according to AARP. However, these supplemental plans may pay your copays and deductibles for covered Medicare services, such as if you need diagnosis and treatment for a covered eye condition.
Medicare may also cover part of the cost of an eye exam if the eye doctor finds that your prescription has changed, but the exam is often the least expensive part. Medicare almost never covers the cost of glasses.
Vision care covered under Medicare
Medicare does pay for vision care to diagnose and treat a specific condition or disease. For example, if you have cataract surgery in which an intraocular lens gets implanted in your eye, Medicare will cover one pair of glasses or one set of contact lenses to help correct your vision afterward.
If you have diabetes, Medicare will pay for one yearly eye exam to check for diabetic retinopathy, according to Medicare.gov. This condition, which can impair your sight, is caused by damage to the blood vessels in the retina from too much sugar in the blood, according to the American Optometric Association.
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And Medicare also may cover tests and treatment for certain diseases or problems of the eye, including age-related macular degeneration, according to Medicare.gov. Age-related macular degeneration is a common condition that can cause blurriness in your central vision, and it's one of the top causes of eyesight problems in people 50 and older, according to the National Eye Institute.
Finally, Medicare covers yearly glaucoma tests for patients at high risk, including people with a family history of glaucoma, people with diabetes, African Americans 50 and older and Hispanic Americans 65 and older, according to Medicare.gov.
If you're being examined or treated for these covered conditions, Medicare Part B, the medical insurance part of Medicare, will cover your glasses, lenses or exam. If you've already met your Medicare Part B yearly deductible, which is $166 in 2016, you'll pay 20 percent coinsurance on the glasses or lenses, or your eye exam, according to Medicare.gov. And your Medigap plan should pick up your copays and deductibles.
However, you can only get your glasses from a provider that is enrolled in Medicare, even if you submit the claim on your own. And, you'll have to pay out of pocket for any frame upgrade you choose.
How Medicare recipients can get vision care
If you want routine eye care covered, you have three main options:
- Traditional Medicare plus a separate vision insurance policy. You can buy a stand-alone vision insurance policy that will cover your exams and contacts or eyeglasses. There are two main types of plans available: discount plans that give you a set discount such as 20 percent off in exchange for a yearly fee; or benefits plans, which pay for exams or corrective lenses up to a certain limit and require you to pay a copay, according to the AARP.
- A Medicare Advantage plan that includes eye care coverage. Medicare Advantage plans must cover everything traditional Medicare does, but some offer additional coverage that may include eye exams and possibly contacts or eyeglasses. However, know that there may be dollar limits on coverage. For example, some BlueCross BlueShield plans that cover glasses fully cover the cost of the lenses but offer only $100 toward the cost of the frames every two years.
- Free eye care from a nonprofit organization. There are also some nonprofit organizations that offer vision care to seniors. For example, EyeCare America, a program from the American Academy of Ophthalmology, offers free medical eye exams from volunteer ophthalmologists to seniors 65 and older who are U.S. citizens or legal residents and haven't seen an ophthalmologist in more than three years. The program also provides a year of care for any eye condition diagnosed through the exam. And Lions Clubs International provides assistance with vision care and offers free recycled eyeglasses to individuals who qualify based on income.