For all that Medicare does offer concerning healthcare, it actually doesn’t provide any coverage for vision services such as routine eye exams, contact lenses or eyeglasses. However, in certain circumstances that Medicare calls “medically necessary,” they will cover certain types of eye care.
Eye care is very important for all people. The Center for Disease Control and Prevention (CDC) says that vision impairments, and even blindness, are increasing among all people, regardless of race or ethnic background. The CDC believes that if people receive preventative eye care, such as routine eye exams, vision problems could be decreased by up to 50%.
Generally speaking, Medicare Part A and Part B do not cover routine eye exams, nor do they cover contact lenses or eyeglasses. However, Medicare Part B does have a benefit that will allow a beneficiary to get an annual eye exam every 12 months. However, this is for people with diabetes who are at a higher risk of contracting glaucoma if they do not stay current on their eye exams.
If you are looking to enroll in a Medicare plan that includes routine eye exams and more, your best option is to look at Medicare Advantage plans. Medicare Advantage is also referred to as Medicare Part C coverage. This is just another benefit of having Medicare Part C; it comes with extra benefits that Part A and Part B might not have. Note, even though the routine eye exams are coming from your Part C coverage, if you enrolled in it, beneficiaries still must pay their Part B premium to keep their Part C coverage. Keep in mind, not all of Part C plans with routine eye care may be offered in your area.
Medicare does not offer a standard vision plan that covers eyeglasses for beneficiaries. However, if a Medicare beneficiary with Medicare Part A and Part B has had cataract surgery, Part B can help. The person would have had to have intraocular lens implants, then Part B could help to offset the costs of the corrective or contact lenses.
Medicaid has very strict rules on what your total household income can be for you to qualify to receive Medicaid benefits. But, if you meet their criteria, you and your family can receive eye care, including routine eye exams and more. Medicaid covers comprehensive eye exams and basic eye exams which could include procedures such as pupil dilation, glaucoma checks, color blindness checks, and many more preventative exams.
If you qualify, Medicaid also covers eyeglasses which include lenses, fittings, and frames. Repairs and replacements of glasses are offered as well.
If you have been reading through your Medicare policy coverage Part A, Part B, Part C, Part D, and other coverages, you might have come across the term “medically necessary.” This term can be significant for a beneficiary if they were previously told that Medicare would not cover a surgery they needed. If after further review, Medicare assesses your situation and determines that you need the surgery for your well-being, more often than not, they will help cover some of the costs for the procedure.
If a beneficiary already has glaucoma or degenerative eye disease or cataracts, Medicare does not want these conditions to worsen. If Medicare determines that some of your eye procedures or surgeries are medically necessary, your Medicare Part B would be the one to help offset some of these procedures and surgeries.
Most people 65 years or older are eligible for premium-free Medicare Part A coverage. However, Part B is not free and has a premium associated with it. If you’re looking to add a Part B policy to your Medicare Part A coverage, the monthly premium is based on the beneficiary’s income; the more you make, the more you pay. For example, if you make less than $85,000 per year, your monthly premium will be $134. If you make over $160,000 a year, your monthly Part B premium will be $428.60.
In addition to paying a monthly premium for Part B coverage, remember that Part B also comes with the yearly deductible of $183. There could also be a co-pay for outpatient services. When a bill comes in that falls into the Part B bucket, the beneficiary is responsible for 20%, and Part B picks up the remaining 80%.
Note: Even with the medically necessary criteria above, routine services such as eye exams are still not covered.
For more information about Medicare, and what it does and does not cover, contact the experts at 844-236-0228. Our licensed insurance experts will be happy to answer any questions you have.