Goes Blue Cross Blue Shield of Rhode Island Plan 65 Delect C Pay for Eyeglasses

Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.

Does Medicare Cover Vision And Glasses?

Original Medicare does not cover routine vision exams or glasses, but Part B (medical insurance) helps cover certain vision-related services if you have eye disease or injury.

Medicare Advantage (MA) Plans, an alternative to Original Medicare, provide the same coverage as Part B, plus more. Most MA plans offer some coverage for routine eye exams and corrective lenses.

Part B vision care coverage is limited to medically necessary treatment for your eye problems. Some of the eye conditions covered by Part B may be a common and normal part of aging and are considered to be Medicare-covered services. MA plans include all Medicare-covered services plus some non-covered Medicare services, such as routine eye exams and financial allowances for corrective lenses.

What Vision Care Is Covered By Medicare?

Medicare Part B helps pay for these medically necessary vision-related services:

• Cataract surgery if it's done using lasers or traditional surgical techniques. This procedure replaces your cloudy lens, which is the source of your blurry vision, with a clear artificial lens called an intraocular lens ("inside the eye").
• Corrective lenses if you have cataract surgery – either one pair of eyeglasses with standard frames or one set of contact lenses from a supplier who is enrolled in Medicare.
• Glaucoma screening test once every 12 months if you are at risk for glaucoma, which is increased pressure within the eyeball that adversely impacts your sight over time. Risk factors for glaucoma are:
  • Diabetes
  • A family history of glaucoma
  • If you are African American and aged 50 or older
  • If you are Hispanic and aged 65 or older
• Yearly eye exam for diabetic retinopathy if you have diabetes. Retinopathy is a disease of the retina, the back part of your eyeball that interacts with your optic nerve to form a visual image. This exam must be done by an eye doctor who is legally allowed to do the exam in your state. Treatments may include medications, laser treatments, and surgery.
• If you have age-related macular degeneration (AMD), Part B may cover certain diagnostic tests and treatment of eye diseases and conditions. The macula is the small central portion of your retina, and as it wears down, it causes loss of vision. Treatment may include medications, laser treatments, and vision aids.

Medicare Advantage plans provide the same coverage as Part B does for medically necessary vision care and some coverage for routine eye exams and corrective lenses.

Which Medicare Plans Are Best If You Need Vision Care?

Medicare Advantage Plans are best if you need vision care. MA plans cover all services that Original Medicare Part B does, plus help with routine eye exams and corrective lenses.

According to the Kaiser Family Foundation, 98% of individual Medicare Advantage Plans and 96% of Special Needs Plans (SNPs) available in the U.S. in 2022 offer some vision benefits. You generally must choose in-network providers and may need to obtain referrals and prior authorization.

Details about vision care benefits you can receive and how much you pay are outlined in each plan's Evidence of Coverage (EOC) or Summary of Benefits documents. Some plans offer additional vision care coverage for an additional monthly premium.

Here is a comparison chart of five MA insurance companies, all HMO plans, to give you an idea of what non-Medicare vision coverage may be available to you in your area (derived from each plan's 2022 EOC or Summary of Benefits docs):

You can search for plans on the Medicare website. If you anticipate the need for vision care and corrective lenses, it's a good idea to check with your eye care provider to see if they are in-network with the plan you choose.

How Much Does Vision Care Cost With Medicare?

Vision care costs depend on what your needs are and what type of Medicare insurance you have.

With Original Medicare, you pay 100% for eye exams for eyeglasses or contact lenses. If you receive vision care that is medically necessary, Part B coverage kicks in and you pay 20% of the Medicare-approved amount for doctor's services after you satisfy your annual Part B deductible ($233 for 2022). If the service is in a hospital outpatient setting, you also pay a copayment. Your total out-of-pocket costs will depend on:

• Other insurance you may have
• How much your doctor charges
• Whether or not your doctor accepts Medicare assignments
• The type and place you get your test, item, or service

Talk with your provider to find out more about your out-of-pocket costs with Original Medicare.

If you have a MA plan, vision care costs vary depending on your plan. All MA plans offer the same Medicare-covered, medically necessary benefits as Part B. Still, you typically must receive care from in-network providers, and your copay/coinsurance structure may be different.

Some MA plans have a $0 monthly premium (although you still pay your Part B monthly premium of $170.10 for 2022) for vision benefits. Some MA plans offer supplemental vision care coverage for a monthly premium ranging from about $10 to $70. Most MA plans with vision care have an allowance that you can apply toward the purchase of either eyeglasses or contact lenses. Depending on the plan, this allowance can be used once every 12 or 24 months and ranges from $100 to $200. Any other costs related to corrective lenses are your responsibility.

Whether you have Original Medicare or a MA plan, medically necessary vision care is considered a Medicare-covered benefit. You are eligible to receive services from approved providers, and you may be responsible for a portion of the costs in the form of a copay or coinsurance.

If your vision care needs are considered to be non-Medicare-covered, such as routine exams and corrective lenses, MA plans typically offer some benefits to decrease your out-of-pocket expenses. Of note, your out-of-pocket costs for these services do not go toward your maximum out-of-pocket limit for your medical coverage.

Is An Ophthalmologist Covered By Medicare?

As a specialist in eye and vision care, an ophthalmologist diagnoses and treats eye diseases, provides medical and surgical interventions, and prescribes and fits corrective lenses. Medicare will help pay for ophthalmologist services in cases of medical and surgical concerns related to the eyes. Original Medicare will not pay for routine eye exams or corrective lenses whether you receive them from an ophthalmologist or optometrist.

MA plans with vision benefits will help pay for in-network ophthalmologist services. You may be required to obtain a referral or prior authorization and may incur a specialist copay and/or coinsurance for exams or surgical procedures. Contact your plan, discuss your coverage with your vision care provider, or review the EOC or Summary of Benefits for details to determine your benefits and what you have to pay.

Learn More From Our Sources

• Medicare | Routine Eye Exams | Last accessed July 2022
• Medicare | Eye exams if you have Diabetes | Last accessed July 2022
• Medicare | Glaucoma Screening | Last accessed July 2022
• Medicare | Macular Degeneration Tests and Treatments | Last accessed July 2022
• Medicare | Cataract Benefits | Last accessed July 2022
• Humana HMO | Summary of Benefits United Health Care AARP HMO | Evidence of Coverage | Last accessed July 2022
• Anthem BCBS HMO | Evidence of Coverage | Last accessed July 2022
• Kaiser Permanente Senior Advantage Core HMO | Summary of Benefits Aetna HMO | Evidence of Coverage | Last accessed July 2022

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Source: https://www.medicareplans.com/does-medicare-cover-eyeglasses-or-vision-exams/

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