Let’s get this out of the way first: Only certain Medicare Advantage plans include your typical, “vision benefits.” Original Medicare – which is Medicare Part A and Part B – does not cover routine eye exams.
While Part B of Medicare does not cover basic eye examination, it will cover certain types of preventive and diagnostic eye exams. These may include the following a(n):
Similar to with the other eye-related exams, the costs for these tests to you will be 20% of the Medicare approved amount for the drug and the doctor’s services, as well as the Medicare Part B annual deductible. Likewise, if the examination takes place in a hospital outpatient setting, you could also be responsible for paying a co-payment.
In order to more closely determine how much a certain vision related test, item, or service may cost, you should talk to your doctor or other health care provider. The actual amount of any exam can depend on a number of factors. These include:
Original Medicare (Part A and Part B) does not generally cover either eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B may help you to pay for corrective lenses. This includes either one pair of eyeglasses or one set of contact lenses. All individuals who are enrolled in Medicare Part B are covered for this particular benefit.
Medicare will only pay for eyeglasses or contact lenses that are provided by a supplier that is also enrolled in Medicare – regardless of who submits the claim.
When getting glasses or contact lenses this way, you may be required to pay 20% of the Medicare approved amount for one pair of glasses or one set of contact lenses after each cataract surgery with an intraocular lens.
In addition, you could be required to pay any additional costs if you purchase items such as upgraded eyeglass frames. And, you will need to pay for 100% of any non-covered services. The Medicare Part B deductible will also apply.
In order to get a better idea of how much your items may cost, you should speak directly with your doctor or your other health care provider. This is because the specific amount that you will owe can depend on a number of different factors.
These criteria can include any other insurance coverage that you may have, the amount that your doctor and / or supplier charges, whether or not your doctor and / or supplier accepts Medicare assignment, the type of facility where you obtain your services, and the location where you get your test, items and / or services.
If you want vision benefits included in your Medicare coverage, you’ve got to buy it either as a policy separate from your PDP or your Medicare supplement policy (here’s a decent example) or buy a Medicare Advantage plan that includes it.
Many Medicare Advantage plans will offer coverage for vision related benefits, which can include eye exams, as well as coverage for eyeglass frames and lenses and for contact lenses. Medicare Advantage plans are offered through private insurance companies like United Healthcare, Aetna and Humana. The benefits all these plans offer can differ wildly. Use an independent insurance agent to determine the best fit for you.
Got a Medicare question? We love questions. Contact us.
Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.