Routine vision care for Medicare patients: What’s Covered?

All, Medicare, Medicare Advantage, Medicare Part B

If you’re holding restaurant menus further away and enlarging the text on your cell phone to the point strangers can read it, a vision checkup might be in order. You might be surprised to learn that Medicare does not cover routine vision services. Here are some options to make sure you keep things in focus.

Why doesn’t Medicare cover routine vision services?

When Congress signed Medicare into law in 1965, vision benefits were not offered under traditional insurance. Fast forward a few decades, and most employers offer dental, vision, and hearing services to their employees. Unfortunately, with the funding issues with Medicare, it’s unlikely Congress will ever add vision services.

It’s important to note that Medicare DOES provide Part B coverage for diseases and illnesses of your eyes, such as glaucoma, macular degeneration, or cataracts.

So, if you simply need an eye exam and glasses or contacts, what are your options?

How can I obtain routine vision coverage?

There are dozens of affordable individual insurance plans that cover your routine vision. You can bundle vision with dental and/or hearing services since those also are not covered by Medicare.

Many plans allow you to treat with your own doctor or dentist and the plan reimburses a percentage of the actual bill. 

What about Medicare Advantage plans?

The federal government allows Medicare Advantage plans to include some extras, or ancillary benefits, in their plan designs.

Benefits vary widely and change from year to year. For example, you may pay a copay for an eye exam, with no coverage for glasses or contacts. Other plans may include a credit or reimbursement toward the cost of glasses or contacts and this benefit may be annually or every two years.

I don’t have vision coverage and don’t want to purchase a plan. Now what?

For a simple annual exam, cash is king. Call around to several providers and ask for the price of the eye exam. Ask about any discounts for seniors paying cash since this saves the vision center the hassle of having to bill insurance.

Also, if you have a health savings account from before retirement, the IRS considers routine vision a qualified medical expense, so you can use HSA funds to pay for vision care.

Diane “Dee” Lee Insurance is an experienced, licensed insurance broker and representative providing Medicare (parts A and B), supplemental Medicare, Medicare Advantage (part C) and Medicare Prescription Drug (part D) plans. Diane Dee Lee Insurance also provides healthcare plans to cover dental, vision, hospital stays, home health care and more. She also serves the under 65 population. Serving as an Insurance Broker in Anthem, Scottsdale, Cave Creek, Deer Valley, Peoria, Glendale, the Phoenix-metro area, Queen Creek, as well as the counties of Pima, Pinal, Coconino, Gila, Mohave, Apache, Navajo, Maricopa and Yavapai. Licensed in seven states and appointed with multiple insurance carriers, Dee is available to meet in person (with necessary social distancing guidelines) or virtually and is licensed in 13 states (AZ, CA, FL, IL, IN, MI, MN, NV, TX, UT, VA, WA, WI). Please call (623) 251-6612 or email dleeski@reagan.com