Does Medicare cover vision care?

May 10, 2021
aspire blog - Does Medicare cover vision care?

Taking care of your vision health is a big part of your overall health and wellness. According to the Centers for Disease Control and Prevention (CDC), about 11 million Americans over age 12 need vision correction, highlighting the importance of regular eye exams to preserve your vision and detect eye diseases early. If you are looking for a Medicare coverage option that helps you focus on taking care of your vision health, it is important to know what choices are available to you.

Does Medicare cover vision care? Yes and no. Let’s break down vision coverage by Medicare type:

Original Medicare (Medicare Parts A and B)

Medicare Part A, known as hospital insurance, only covers vision care when the vision condition is considered a medical problem. For example, if it’s a medical emergency or traumatic injury to the eye. Medicare Part B, known as medical insurance, covers some vision care, however it does not cover routine vision care such as vision exams, eyeglasses (frames or lenses), or contact lenses. This means that without any additional coverage you would need to pay for these costs out of pocket.

Vision care covered under Part B includes glaucoma tests, yearly eye exams to test for diabetic retinopathy, eye tests for macular degeneration, cataract surgery and prescription lenses or eyeglasses in certain situations (i.e., vision correction after cataract surgery).

Medicare Advantage plans (Medicare Part C)

Medicare Advantage (MA) plans offer optional coverage that goes beyond Original Medicare including extra benefits (like vision coverage) designed to save you money. MA plans cover the same services as Original Medicare and more. Coverage options vary by plan and can include routine eye exams, eyeglasses, contacts, and fittings for frames and contact lenses. Some plans offer this as an enhanced benefit and others include it in their core product.

Medicare prescription drug coverage (Part D)

You can enroll in either a Medicare Part D plan or an MA plan with Part D coverage (known as an MAPD plan) to help pay for prescription drugs. These plans can help pay for products related to your vision care including eye drops or other vision-related prescriptions from your doctor.

Medicare Supplement plans (MedSupp)

Medicare supplemental insurance plans (aka MedSupp or Medigap) cover costs not covered by Original Medicare including copays, deductibles and coinsurance. These plans do not include routine vision coverage.

Turning 65 means you’ll have important choices to make about your healthcare. To make the most of Medicare, you need to understand your options and how they work. Aspire Health Plan is here to answer any Medicare questions you may have. Give us a call at your convenience for friendly, no-obligation advice. Call (855) 378-9680. (TTY users call 711.)

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