Does Medicare Cover Vision?
Original Medicare: Parts A and B
With Original Medicare, you pay for services as you get them. When you go to the doctor and it’s covered under your Medicare, it’s called a covered service. With a covered service, Medicare pays part of the cost and you pay the rest. One of the best parts of this plan is that you can see any doctor or hospital that takes Medicare. This includes anywhere in the U.S and you almost never need a referral.
Here is a breakdown of what you can expect from your Part A and B coverage:
Items covered through Parts A and B:
Part A-Hospital Insurance: this helps cover:
Inpatient care in hospitals
Skilled nursing facility care
Hospice care, and home healthcare
Part B-Medical Insurance:
Services from doctors and other health care providers
Durable medical equipment
Many preventative services such as screenings, shots or vaccines, and yearly “Wellness” visits
Please remember that with this Medicare plan, the prescription coverage, which is Part D, is not covered. It can be added as supplemental coverage though.
Items not automatically covered through Parts A and B:
Routine vision care/eye exams–the only vision care you will have under Original Medicare is emergency care. That is if something goes wrong with your eyes and you have to be hospitalized.
Routine dental care/cleaning
Medicare Advantage: Part C
Medicare Part C is also known as the Advantage Plan. A private insurance company partners with Medicare to offer this plan. You can click here to check out the four different types of Advantage Plans.
Chances are, this plan will likely cost you less money than Original Medicare. Also, it offers benefits that Original Medicare doesn’t cover that you would end up paying out of pocket for. One example of this is routine vision care. With many different plan options, it’s always a good idea to take your time researching. Make sure you are getting the coverage that’s best for your individual situation.
A few things to know about the Advantage plan (part C):
– It is a different way to get the original Medicare benefits (A and B)
– You will enroll with a private company that is contracted with Medicare
– You will often have the added benefits of routine dental or vision care
– Many private companies come with their own “in-network” providers that you must use or else pay out of pocket for those that aren’t in network
Medicare, Vision, and Risk Factors
So does Medicare cover vision? As you can see from the above information, there is a way to have your vision covered. You have to pay attention to what plan you’re getting, though. There are some things you should take inventory of before making the decision. For example, have you ever had any issues with your eyes that put you in a high-risk category?
If you don’t know the answer to this question, you should consider checking in with your eye doctor first. Now, what is “high risk” and what might it mean for you?
Risk Factor #1: Glaucoma
Do you have a family history of Glaucoma that you might develop at some point? With Medicare Part B, you will get one preventative vision screen because you are at risk for Glaucoma. This might be enough on its own if you don’t have other risk factors for your vision.
Risk Factor #2: Cataracts and Cataract Surgery
Cataracts are another factor you should be aware of as you make plans to switch to Medicare. For the most part, Medicare will cover the cost of cataract surgery and lens replacement. Following cataract surgery is the only time that Medicare A and B will cover the cost of new glasses or contact lenses. Otherwise, you will need to enroll in an Advantage Plan to cover these expenses.
Risk Factor #3: Eye Protheses
Medicare Part B will cover an artificial eye due to a birth defect, vision trauma, or surgery. Coverage includes a replacement once every 5 years.
Risk Factor #4: Macular Degeneration
According to the National Institute of Health, Macular Degeneration is the biggest cause of vision loss in those who are aging. It is not exactly a type of “high-risk factor” as the others mentioned so far. But, it is still something people aged 65 and above should consider. Because of this, Medicare Part B and Medicare Advantage can help. Their vision benefits may cover costs for diagnosis and prescription drugs needed to treat it.
So…who does Medicare cover vision for?
Medicare can feel like it’s a bit of a puzzle to figure out with the different parts. If you are 65 or older there is a plan for you. There are Medicare options that will offer enough vision coverage to make you feel safe. Here are some easy steps you can take to get started.
— A good place to start is by going to see your eye doctor.
— Ask for advice on what they think you might need in the years to come
— Find out how much coverage could be necessary
— Find out if they are in-network with any Medicare plans. This is important to do if you want to continue seeing the eye doctor you already have.
— Compile a list of private companies that contract with Medicare (see step 3 first)
— Make some phone calls and get quotes from a few that seem like they would be a good choice
Medicare is a great option for those in our country aged 65 and above. Ask questions, and don’t hesitate to involve those that know your medical history. The right plan for your Medicare vision coverage is out there. At Medicare Insurance of Arizona, we will guide you through each of the steps above. Call us anytime.
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