Does Medicare Cover Vision

In the world of health insurance, it is often overwhelming to figure out what is covered and what isn’t covered. Are you 65 years or above? Are you switching from private insurance to Medicare? If yes to either of these, you might be trying to figure out what changes there will be to your insurance. For people that need help with their eyesight, things can get even more complicated. You are probably already wondering, does Medicare cover vision?

The answer is both yes and no. Confused yet? Keep reading to gain some insight. The ins and outs of Medicare is what we’re good at. These are the things you’ll need to know before booking your next eye doctor appointment.

What is Medicare?

Let’s start at the beginning. What is Medicare? Medicare is insurance for people aged 65 or above. You are eligible to sign up for Medicare three months before you turn 65. Before you sign up though, you should do some research on what plan might be best for you. It’s true that most options contain many of the same benefits. However, there are small differences. Depending on your health, or even your health history, at the time of registration, these small differences could be big.

The many parts of Medicare

There are some different moving parts to Medicare plans. It’s a good idea to think about what you feel will be best suited for your individual health needs. For complete information on this, you can always check the Government Medicare site. Original Medicare has many subcategories. Parts A, B, and then part C: Medicare Advantage. Let’s take a closer look at how these break down.

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

Outpatient care

Home healthcare

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:

Prescription drugs

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.

We’re here to help! Call us today.

480-771-0505

Call us

480-771-0505 (TTY:711)

We are Open

Mon - Fri, 8:30 AM – 5:00 PM

Blog