This is a question I hear often from individuals start enrolling in Medicare. They are typically leaving a work plan and they have heard they need to get a vision plan because Medicare doesn’t cover vision care services.
How can that be?
Original Medicare, Part A and Part B, offers limited vision coverage, and you’re not covered for most routine eye care. – eHealth Medicare
But, if you have a symptom or a problem with your eyes requiring it, that will be covered with a copay under Part B as outpatient care. For example, if you get cataract surgery while on Medicare, Medicare will give you a credit for a pair of glasses. (This does not flow through your insurance plan. It is a direct credit from Medicare.)
Medicare Part B covers vision tests to
- Diagnose macular degeneration
- Provide glaucoma screening once a year if you’re in a high risk group
- Check for diabetic retinopathy.
Be aware that in some cases, Medicare doesn’t always cover ALL required exams even when there is an underlying cause. If as a diabetic, you need to get your eyes checked more than once a year, Medicare will only cover the first one. If you need your eyes checked two or three times a year for your diabetes, you will be out of pocket for that expense.
Medicare Advantage Plans
When you apply for a Medicare Advantage Plan, most carriers give you an annual eye exam once a year with no questions asked. You’ll also receive a small credit, between $100 and $300 being normal, to help cover the cost of glasses.
A few major carriers I work with typically do not charge a copay if you have a problem and need to get your eyes looked at because of a symptom.
Vision Care Costs
Most work done on your eyes goes through your Outpatient Part B coverage. With only original Medicare would cover 80% of the bill and you would be responsible for 20% of the bill for an eye procedure.
My clients who had cataract surgeries would come back and tell me that they were out of pocket around $600 to $800 per eye!
There are certain plans that provide much better coverage than this, such as the Medicare Supplement G plan.
The way Part B works on this plan is that you have to cover the Part B deductible once a year, which currently is $203. Once that is covered, you do not pay a copay or get a bill for any Medicare approved Part B outpatient procedure, so you can get both eyes done and the worst-case scenario is you have to pay your deductible of $203.
Most Advantage plans I work with have a capped outpatient fee. On average, it would cost $350.00 per procedure. Please be aware of the Advantage Plans in our Marketplace still charging 20% for outpatient procedures. They are out there and there is no reason to be on that plan.
Medicare offers limited vision care coverage
By applying for a Medicare Advantage Plan, you extra vision benefits including:
- A credit for glasses typically $100 to $300
- An annual eye exam one a year
- Additional exams when you have a symptom, typically at no copay.
And if you have eye surgery it goes through outpatient procedures where most carriers are capped at around $350 per outpatient.
If you are on the “Cadillac” of Medicare supplement plans, the “G plan,” you have a fewer extra benefits but more coverage:
- If you have any eye procedure on the G plan, you pay nothing for that Part B procedure. You’re only responsibility is to cover the once a year deductible of $203.00
The trade off is no additional eye exams or credit for glasses. (Though most carriers will market coupons to you directing you to retail stores who will give you a discounted price and exams if you purchase glasses from them.)
Is it necessary to purchase a separate vision care plan?
In most cases, I do not see the value. You will pay around $20.00 per month to get a small credit for glasses and an eye exam. Most major retail vision companies have big discounts on glasses and will check your eyes for free or a discount if you buy glasses.
What plan is best for you?
Hopefully this provides a bit of clarity, but it can still be very confusing. If you are unsure of what coverage you have, if you are thinking you need to make a change, or would like to get any of your vision care questions answered, contact me.
In the meantime, remember to always ask your doctor as they suggest eye procedures:
“Does Medicare cover this?”
These words can save a lot of confusion.
Be well, be safe, and have a blessed day!
Brian Johnson, LUTCF