As you get older, you may find that your eyesight isn’t what it used to be, and it’s likely you’ll need corrective lenses at some point. According to the Centers for Disease Control (CDC), 92% of adults age 70 and older wear prescription eyeglasses. Roughly 1.8 million seniors report limitations in daily activities due to vision issues, including getting dressed or even walking around their home. In fact, CDC data suggests that vision problems may be a major risk factor in falls among the elderly.
If you’re a Medicare beneficiary, you may be wondering whether Medicare covers corrective lenses, such as eyeglasses or contact lenses. Unfortunately, if you are enrolled in Original Medicare (Part A and Part B) and you need prescription eyeglasses or contact lenses, you’ll need to pay for these out of pocket in most cases. With a few exceptions, Original Medicare generally doesn’t cover costs for routine vision care.
As an alternative to Original Medicare, you may be able to find a Medicare Advantage plan that includes vision coverage and helps with the cost of eyeglasses, including fitting exams, frames, and lenses. Read on to learn more about your coverage options.
Does Medicare cover eyeglasses?
As mentioned, Medicare generally doesn’t cover routine vision costs. This includes:
Eyeglasses
Frames or lenses
Contact lenses
Routine vision exams
Exams to get fitted for glasses or contacts
There is an exception: if you have had cataract surgery to insert an intraocular lens (IOL), Medicare Part B covers one pair of corrective lenses (either one pair of prescription eyeglasses or contact lenses). You must purchase your eyeglasses or contact lenses from a supplier who is enrolled in the Medicare program to be covered, and you’ll owe a coinsurance of 20% of the Medicare-approved amount for the glasses or contact lenses, after you’ve reached the Part B deductible.
Certain frames may be considered upgrades, and you are responsible for any additional costs for upgraded eyeglasses.
Keep in mind that this benefit applies each time you have cataract surgery to insert an intraocular lens. So if you have cataract surgery with an IOL placement for one eye, Part B will cover the cost of one pair of eyeglasses or contact lenses. And if, six months later, you have cataract surgery for the other eye, Part B will again cover one pair of eyeglasses or contact lenses with your new prescription.
If you wear prescription eyeglasses for any other eye condition, or to correct routine vision issues, Original Medicare doesn’t typically cover the costs.
Do Medicare Advantage plans cover eyeglasses?
You may have other options as a Medicare beneficiary if you’d like help covering the cost of eyeglasses. Medicare Advantage, also called Medicare Part C, is required by law to cover everything that Original Medicare covers, except hospice care, which is still covered under Part A. The main difference is that instead of getting your Part A and Part B benefits through the federal program, your coverage is administered through your Medicare Advantage plan, which is available through Medicare-contracted private insurance companies. Your costs may also be different than Original Medicare.
In addition, many Medicare Advantage plans offer additional benefits, including routine vision or dental, hearing services, or wellness programs. In many cases, you may be able to find a plan in your area that pays all or part of the costs associated with prescription eyeglasses, contact lenses, annual exams, or fittings. You may have to pay a deductible before your Part C benefits apply, depending on the plan. Not every Medicare Advantage plan includes vision benefits, so if you’re interested in finding a plan with vision coverage, check with the specific plan before enrolling.
It’s important to note that you must continue to pay your Part B premium even if you enroll in a Medicare Advantage plan, plus any additional monthly premium your plan may require. Some Medicare Advantage plans may have a monthly premium as low as $0, but even in this case, you’ll need to keep paying your Part B premium to keep this coverage.
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