With the Medicare enrollment period fast approaching, the chances are that you are scrambling to find the right health insurance plan for your needs. And, if you are anticipating the need for eye and vision care services, you are probably wondering what Medicare will cover.
While navigating the universe of Medicare insurance plans is all but easy, enrolling in the right coverage will give you access to the care you need. Learn all you need to know in the guide below.
Included Medically-Necessary Vision Services Under Medicare
Thanks to the introduction of the Affordable Care Act and Medicare, the number of uninsured adults in the US reached an all-time low in 2016, and, today, only 1% of the population aged 65 and over doesn't have insurance.
What's more, according to KFF statistics , over 99% of Medicare beneficiaries live in an area where at least one Medicare Advantage plan is available, thus giving them access to vision care coverage.
Nonetheless, understanding what vision and eye care services are included under each plan remains a significant plan for older adults. Generally, Medicare covers the following medically-necessary services:
- Surgical procedures that restore eye functions affected by chronic or severe conditions (i.e.: cataract removal and eye lens replacement)
- Prescription eyeglasses and lenses necessary to restore vision after cataract surgery
- Diagnostic eye exams necessary to identify serious eye conditions
Medicare Plans That Cover Medically-Necessary Eye Care
When looking for a good health insurance plan , it is important to understand what healthcare services, procedures, and medications you need your plan to cover. And, since eye care needs vary from one person to another, you should look at how the different Medicare Parts compare:
- Medicare Part A - also known as Hospital Insurance, Medicare Part A can cover medically-necessary eye care, but only if the vision problem or traumatic injury requires hospitalisation.
- Medicare Part B - also known as Medical Insurance, Medicare Part B can cover up to 80% of eye care costs made necessary by underlying conditions, such as diabetes and glaucoma.
- Medicare Part C (or Medicare Advantage Plans) - Medicare Advantage Plans can offer additional eye and vision care benefits, alongside dental and hearing services, which might vary according to the provider.
- Medigap - Medigap is a supplemental type of insurance that can help you cover the cost of eye surgery and other services. (Not available to Medicare Advantage users).
Accessing Vision Services With Medicare
As a rule, unless they are deemed considered to be medically necessary, Original Medicare will not cover routine eye exams, eyeglasses, and contact lenses, and you will have to absorb 100% of the cost of these services.
Nonetheless, as you learn more about Medicare and your coverage options , you'll find that there are alternative ways to access the services you need. Here's what you need to know.
Routine Eye and Vision Exams
Original Medicare does not cover standard routine eye exams (i.e.: refractions), and you'll have to absorb the entire cost of these services, which range between $50 and $70.
However, you'll be able to access free or discounted routine eye tests if:
- You have diabetes
- You have glaucoma
- You are at high-risk for glaucoma (i.e.: you have diabetes, hold a family history of glaucoma, are African American above 50 years of age, or are Hispanic American over 65 years of age).
Original Medicare does not cover the cost of eyeglasses or contact lenses unless these are deemed to be medically necessary. However, if you have undergone cataract surgery, Medicare Plan B can help you cover up to 80% of the cost of corrective lenses.
Eye Surgery
Medicare plans can cover up to 80% of the costs of eye procedures such as cataract surgery once the deductible is met.
Generally, the procedures covered by Medicare are the ones necessary to restore essential eye functions. In turn, LASIK and other corrective procedures are excluded.
Finding an Eye Doctor Who Accepts Medicare
Before choosing your Medicare or Medicare Advantage plan, it is important to review the list of in-network providers and facilities.
While Medicare Advantage Plans offer better coverage for vision services, this kind of insurance differs from Medicare in that you might only be able to use doctors in the provider's network or have to request a referral to see a specialist.
If in doubt, check with your provider or directly with Medicare if a certain procedure, service, or facility is included in your plan. And, don't forget to complete your due diligence before the enrollment period comes around!