What Vision Care for Seniors does Medicare Cover?

There are a few specific conditions in which Original Medicare (Part A and Part B) will cover all or part of the cost of vision care for seniors.  Let’s take a look at what each part covers.

Medicare Part A

Medicare Part A (Hospital Insurance) will cover vision services if they require inpatient hospitalization such as a traumatic injury or medical emergency.

Medicare Part B

Medicare Part B (Medical Insurance) covers doctors’ visits, outpatient services, and medical supplies for certain vision care services such as:

• Detached retina
• Eye cancer
• Scratched eye
• Eye prostheses
• Annual glaucoma screening for high-risk individuals
• Diagnosis and treatment for macular degeneration
• Cataract surgery and artificial lens replacement

It is important to note, although Medicare Part B will cover treatment for these specific conditions it does not cover all of the costs.  Typically, Medicare will pay for 80% of the treatment leaving you responsible for the remainder 20%, in addition to the Part B deductible and premium.

What Vision Care for Seniors does Medicare Not Cover?

Medicare does not cover traditional vision care unless it is deemed medically necessary as in the instances above.  As a result, you will be responsible for 100% of the cost of any vision care service you receive unless you have separate vision coverage.  Generally speaking, Medicare does not cover the following vision care services:

• Regular eye exams
• Prescription eyeglasses or sunglasses
• Contacts
• LASIK surgery

Options for Vision Health Coverage

Vision healthcare coverage can be especially important to individuals who require routine eye exams or for those who wear prescription eyeglasses or contact lenses. The gap in coverage for retirees who no longer receive vision coverage from their employers can be shocking.  Fortunately, there are a few options you can choose to supplement vision coverage while enrolled in Medicare.

• Medicare Advantage
  Medicare Advantage, also known as Part C, offers an alternative way to receive your Medicare Benefits.  Medicare Advantage plans are offered through private insurance companies contracted with Medicare and often provide extra vision benefits not provided by Original Medicare.  Some Medicare Advantage plans offer full coverage for routine eye exams, eyeglass lenses, eyeglass frames, and contact lenses.
• Stand-Alone Vision Insurance
  Vision care for seniors is also available through supplemental vision plans. Stand-alone vision coverage plans generally have low monthly premiums but may have limited coverage depending on the plan. Since these stand-alone plans are offered through PPO’s and HMO’s you are also limited to their provider network.  Many plans can help pay for eye exams and offset the cost of prescription glasses and contact lenses.