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Is vision care covered by Medicare? I currently have vision insurance through my employer, but I will lose this coverage when I retire.
Many soon-to-be retirees are often unclear with what Medicare covers when it comes to vision care. The good news is that Medicare pays for most eye-related medical issues like cataract surgery, treatment of eye diseases and medical emergencies. Routine care, such as eye exams and eyeglasses, are usually the responsibility of the beneficiary. Below is an overview of what is included and excluded under Medicare.
Eye exams and treatments: Medicare does not cover routine eye exams that test for eyeglasses or contact lenses, but it does cover yearly medical eye exams for individuals with diabetes or at high risk for glaucoma. Medicare will cover examinations for eye diseases if you are experiencing vision issues that suggest a serious condition, including macular degeneration, dry eye syndrome, glaucoma, eye infections or if a foreign object is present in your eye.
Eye surgeries: Eye surgeries that are not considered medically necessary, including refractive (LASIK) surgery and cosmetic eye surgery, are not covered by Medicare. Medicare does pay for eye surgeries that help repair the eye function, including cataract surgery to remove cataracts and insert standard intraocular lenses. Medicare will not, however, cover the extra cost of premium multifocal lenses that restore the full range of vision, thereby reducing the need for glasses after cataract surgery. The additional cost for premium lenses may range from $1,500 to $4,000 per eye.
Eyeglasses and contact lenses: Medicare will not typically pay for eyeglasses or contact lenses. If you have had a conventional intraocular lens inserted during cataract surgery, Medicare will pay for one pair of eyeglasses or contact lenses following the operation.
Although original Medicare’s vision coverage is limited to medical issues, there are ways to save on routine care. Here are some options to consider.
Medicare Advantage: Many Medicare Advantage plans, which are alternatives to original Medicare and sold through private insurance companies, cover routine eye exams and eyeglasses. Coverage may be limited so be sure to understand the details of what is and is not covered under any plan being considered. Although enrolling in an Advantage plan exclusively for vision coverage is not recommended, it is an option worth considering. To locate Advantage plans in your area that provide vision coverage, go to Medicare.gov/plan-compare or call 800-633-4227.
Purchase vision insurance: If you get routine eye exams and purchase new eyeglasses annually, a vision insurance plan may be worth the premiums. These policies typically range between $5 and $30 per month. Most plans will also have copays or deductibles you will be responsible for.
Check veterans’ benefits: If you are a veteran and qualify for VA health care benefits, you may be able to get some or all your routine vision care through the VA. Go to VA.gov/health-care/about-va-health-benefits/vision-care to learn more.
Find cheaper shopping options: Many retailers provide discounts between 10% to 50% on eye exams and eyeglasses if you belong to a membership group. You can also save by shopping at discount retailers or big box stores.
You could also consider buying your eyeglasses online which may offer savings. To purchase eyeglasses online, you will need a valid prescription from an eye doctor, usually no more than a year old, and your pupillary distance (PD). Your PD is the measurement in millimeters between the centers of your pupils.
Look for assistance: There are health centers and local clinics that provide free or discounted vision exams and eyeglasses to those in need. To find referrals, visit the National Eye Institute online at nei.nih.gov and click on the “Get Help Paying for Eye Care” option.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of “The Savvy Senior” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
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