In this guide, we will outline the parts of Medicare that do and do not cover vision care. We will also discuss the different types of exams and screenings covered, the average Medicare copay involved, and the enrollment options available for people looking into this type of coverage.
What Parts of Medicare Include Coverage for Glasses and Eye Exams?
Original Medicare (which includes both Medicare Part A hospital insurance and Medicare Part B medical insurance) does not cover eye care services. However, there are some exceptions for certain diagnostic tests and treatments.
The good news is that both Medicare Advantage (or Medicare Part C) and Medicare Supplement (or Medigap) plans do cover vision exams, eyeglasses, and contact lenses to some extent. Specific coverage varies depending on your insurance carrier and the plan you choose, as some Medicare insurance providers offer more benefits than others.
Below is a detailed breakdown of how the different parts of Medicare apply vision coverage:
Original Medicare: Minimal Coverage
Original Medicare (Medicare Part A and Part B) does not cover eye exams, eyeglasses, or contacts. Under an Original Medicare plan, you would have to pay for all of the associated costs related to these services.
While private Medicare insurance carriers are required by law to provide at least the same base level of coverage offered by Medicare Part A and Part B, not all offer vision coverage as additional benefits.
However, there are a few exceptions. Medicare Part B does pay for some routine diagnostic tests and treatment for patients with certain risks or eye conditions, such as:
- Annual eye exams for diabetes patients: The patient pays 20% of the Medicare-approved cost of the treatment or service.
- Annual glaucoma tests for at-risk populations: The patient pays 20% of the cost.
- Age-related macular degeneration tests and treatment: The patient pays 20% of the cost.
- Corrective lenses for post-cataract surgery implant and intraocular lenses: The patient pays 20% of the cost issued from a Medicare-enrolled supplier.
Medicare Advantage Plans: Additional Coverage
Fortunately, most Medicare Advantage plans do compensate for the lack of Original Medicare coverage in this area. In addition to vision-related procedures, most Medicare Advantage plans cover hearing and dental services as well.
To get a higher level of vision coverage than is offered through Original Medicare, you need to sign up for a Medicare Advantage plan with a private insurance provider. With a Medicare Advantage plan, you might have to pay a copayment or coinsurance cost for routine eye exams by in-network eye doctors. Most Medicare Advantage plans cover prescription glasses and contact lenses.
For more expansive coverage, you can also add a Medicare Part D prescription drug plan to your Medicare Advantage coverage. This may help cover the cost of certain medications and/or eye drops used to treat vision problems.
While private Medicare insurance carriers are required by law to provide at least the same base level of coverage offered by Medicare Part A and Part B, not all offer vision coverage as additional benefits. For this reason, it is important to be sure you read through your plan carefully to ensure you have the vision coverage you need.
Medicare Supplement Plans: Additional Coverage
Medicare Supplement plans are another option for people who want to enroll in Original Medicare while also getting extra perks, including partial coverage for vision care services. Medigap policies will pay for the remaining costs not covered in Original Medicare, such as copayments, coinsurance, and deductibles. Generally, Medigap plans pay for 20% of the costs not covered under Medicare Part A and Part B.
Like Medicare Advantage, you can also add a Medicare Part D prescription drug plan to your Medigap policy. This will pay for medications associated with your eye care procedures and treatments.
Again, the extent of this coverage varies based upon where you live and the specific plan you choose.
Vision Coverage Enrollment Options
Once you are ready to enroll in a specific plan, it is important to know that there are different enrollment requirements and timeframes for signing up. Below is an outline explaining each as it pertains to vision care specifically.
Medicare Advantage Enrollment For Vision Care
You can sign up for a Medicare Advantage plan every year during the Annual Election Period, which runs from October 15 to December 7. If you want to make changes to your existing Medicare Advantage plan, you have to do so during the Open Enrollment Period, which occurs between January 1 and March 31.
Once you are ready to enroll in a specific plan, it is important to know that there are different enrollment requirements and timeframes for signing up.
Otherwise, you have to join a Medicare Advantage plan during your Initial Enrollment Period. This is the seven-month timeframe starting three months before you turn 65 — at which point you’ll be eligible for Medicare — and extending three months after your 65th birthday. Apart from these time windows, under certain circumstances, you can make changes to your plan during the Special Enrollment Period.
You can find a Medicare Advantage plan by searching through the Medicare.gov website. The site will also list the associated Medicare Part D (prescription drug) plans that you can add.
Medicare Supplement Enrollment For Vision Care
To enroll in a Medicare Supplement or Medigap policy, you must be enrolled in Original Medicare (Part A and Part B). You should sign up for a Medigap plan during your Initial Enrollment Period, which is the six-month timeframe before and after your 65th birthday.
You can find a Medicare Supplement policy through the Medigap search tool. Remember, not all carriers cover the same eye care expenses, so be sure to read through the plan benefits carefully.