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Dear Connie,
I’m new to Medicare and confused about vision coverage. Some friends already enrolled in Medicare say they have coverage, but I don’t see where they’re getting it. Everywhere I read says that Medicare doesn’t cover vision. Or that I need to pay extra for it.
How can I know what’s covered and what’s not? Does Medicare cover vision?
We’re sorry you’re confused about Medicare’s vision coverage. It’s understandable. There are a lot of rules to understand, and coverage isn’t the same from person to person.
If you ask your friends or family members about coverage, their coverage could differ from what you want or need. It’s always beneficial to seek the advice and guidance of a local licensed agent.
We’ll do our best to break down vision coverage for you.
Medicare and eye exams
Original Medicare, your Medicare Part A and B, do not cover routine vision care for things like eye exams for a prescription. If you’re enrolled in Original Medicare and need to pay out-of-pocket, a refractive vision test and patient exam will cost $250 – on average – for a new patient. An existing patient is usually a little less—an average of $155.
Agent tip:
“Original Medicare doesn’t cover routine vision exams or prescription glasses, or contacts. If you want this coverage, you should review your Medicare Advantage plan options.“
Original Medicare Part B will cover eye exams if you’re at higher risk for glaucoma, cataracts, or diabetes.
For example, if you have diabetes-related vision problems. Medicare covers one annual exam by a state-authorized eye doctor. Medicare also covers one yearly eye exam by a state-authorized eye doctor if you have a high risk for glaucoma. High risk means you have diabetes, a family history of glaucoma, are African American and age 50 or older, or are Hispanic American and 65 or older.
Medicare Part B will only cover an eye exam to diagnose potential vision problems. And the exam is covered even if you don’t have a vision problem.
If you want routine eye exams covered, you’ll need to consider enrolling in a Medicare Advantage plan. These plans offer eye exams and comprehensive vision coverage, among other benefits. If you need help deciding which plan is right for your health and budget, a local licensed Connie Health agent can help at (623) 223-8884.
Medicare and prescriptions for eyeglasses & contacts
Original Medicare Parts A and B do not cover the cost of routine prescriptions for eyeglasses and contacts. If you get an eye exam and need to change your eyeglass prescription or get new contacts, Original Medicare does not cover that. You would need to pay out-of-pocket for the expense. Most people spend between $100 to $150 for their prescription eyeglass frames.
However, there is an exception for individuals who have cataract surgery and need an intraocular lens.
In that case, Original Medicare Part B will cover one standard pair of untinted prescription glasses or contacts, if needed, and from a Medicare-authorized provider. After you meet the Part B deductible, you will pay 20% of the Medicare-approved amount for glasses or contacts post-cataract surgery.
If it’s medically necessary, Medicare may pay for customized eyeglasses or contact lenses. However, if you want upgraded prescription lenses or contacts that aren’t medically necessary, you would need to pay out-of-pocket.
If you want your prescription lenses and contacts covered, you’d want to explore enrolling in a Medicare Advantage plan offering comprehensive vision. These plans provide everything that Original Medicare Part B covers and more. To discover if a Medicare Advantage plan is right for your health and budget, speak with a local licensed agent at (623) 223-8884.
Yes, Medicare provides coverage for eye surgery, for instance, cataract surgery. This is when the cataract is removed and replaced with a fabricated intraocular lens. Original Medicare Part B would cover 80% of the cost of traditional cataract surgery. You must pay 20% of the procedure plus the Part B deductible and medications.
I hope that this helped clear up what Medicare vision coverage is offered. While Original Medicare does not cover routine vision, Medicare Advantage plans are an alternative to explore. So, if your friends or family say they have vision coverage, it’s likely because they’re enrolled in a Medicare Advantage plan.
If you’d like to explore Medicare Advantage plans that include comprehensive vision coverage, speak with a local licensed agent. Call (623) 223-8884 to find the right plan for your health and budget.
Connie Health is here to support you throughout your Medicare journey. If you have additional questions, please reach out. We’re happy to help.
Which Medicare plan covers dental, vision, and hearing?
Medicare Advantage plans cover comprehensive dental, vision, and hearing. A Medicare Advantage plan will cover these expenses if you need routine dental, vision, or hearing exams. They also often provide coverage for dental work, prescription eyeglasses and contacts, and hearing aids. These are benefits that Original Medicare and Medicare Supplement plans do not offer.
Want to learn more about Medicare Advantage plans? Call 1 (888) 647-7330 to speak with a local licensed agent and discover if there’s a plan that fits your health and budget needs.
Does Medicare Part B cover dental and vision?
Medicare Part B covers dental and vision in specific circumstances. If you are looking for comprehensive dental and eye exams, plus dental work, prescription glasses, or contacts, then you should explore a Medicare Advantage plan.
Medicare Part B does not cover preventative dental and vision care. However, Medicare Part B will cover dental extractions if they relate to oral surgery in a hospital setting. Part B will also cover cataract surgery and eye exams if you’re at high risk of glaucoma or have diabetes.
If you’d like routine dental and vision care, speak with a local licensed agent at 1 (888) 647-7330. A Connie Health agent can help you find a plan that fits your budget and health needs.
(623) 223-8884 | TTY: 711
(623) 223-8884 | TTY: 711
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