One concern individuals have when enrolling in Medicare is whether the program offers vision coverage. Original Medicare (Part A and Part B) is often criticized for lacking vision coverage, but in reality, it covers vision treatments under certain conditions. As for Medicare Advantage (Part C), vision coverage is possible and is one of its selling points as a policy.
What Vision Treatments Will Original Medicare Cover?
Medicare Part B is the outpatient coverage in Original Medicare. It covers preventive care, outpatient exams and procedures, medical equipment, and emergency transportation.
Routine eye exams aren’t considered medically necessary, so they are not covered under Part B.
Part B will cover the following treatments for the conditions below:
- Age-related macular degeneration (AMD) – screenings and treatments
- Diabetic retinopathy – annual diagnostic screenings (if you have diabetes)
- Glaucoma – annual screenings
- Cataracts – surgery (if done traditionally or with lasers); one pair of prescription eyeglasses or contact lenses
How Does Part B’s Vision Coverage Work?
If Part B covers your treatment, you’ll be responsible for 20% of the cost once Medicare has paid its share. Your exact out-of-pocket cost will depend on the type of treatment and how much your physician charges.
Some healthcare providers are non-participating, meaning they do not accept Medicare assignment. A non-participating healthcare provider may make an exception and accept your Medicare coverage but may charge up to an additional 15% which will be part of your out-of-pocket expense.
What Vision Treatments Will Medicare Advantage Cover?
Medicare Advantage covers everything that Original Medicare does, plus offers coverage for routine visits.
The coverage can be more extensive depending on your specific Medicare Advantage plan. Some will even offer additional vision coverage for an extra $10 to $70 per month.
How Does Medicare Advantage’s Vision Coverage Work Differently?
Aside from covering what Medicare Part B doesn’t, Medicare Advantage differs in how it applies its coverage. For example, your Medicare Advantage plan may provide an allowance from $100 to $200 that you can use once every one or two years to purchase new eyeglasses or contacts.
Many Medicare Advantage plans have an out-of-pocket maximum, which limits the amount you’ll have to spend on your healthcare per year. If you get a vision-related service that is also covered under Part B, your payments will go toward the out-of-pocket maximum. However, what you pay for non-medically necessary vision services does not factor into your out-of-pocket maximum.
It’s encouraged that you make sure you’ll be covered before you go to an appointment. Medicare Advantage often requires policyholders to get referrals from primary care physicians in order to be covered for seeing specialists, such as ophthalmologists and optometrists.
We’ll Make Sure You’re Taken Care Of
You should never have to worry about overpaying for medical expenses. That’s why at My Healthcare Direct, we help you get the best Medicare plan tailored to your needs. Get started today by calling us at (888) 959-1028.