If You Have Medicare, Is Your Vision Care Covered?

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.

In short:

 

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