Medicare Vision Plans

Original Medicare usually does not cover vision-related services unless it is for certain circumstances, such as surgery. However, there are many other options for vision coverage including vision insurance plans, discount vision plans and some Medicare Advantage Plans.

What Does Medicare Cover for Vision?

Original Medicare (Parts A and B) does not cover routine vision, including eye exams, glasses, and contacts. There can be some vision coverage included under Original Medicare, but it must be considered medically necessary and is usually related to chronic conditions. The most commonly covered eye conditions covered by Original Medicare include glaucoma or cataracts. There are additional coverage options to assist with vision care for Medicare beneficiaries, such as vision insurance, vision discount plans, and included vision benefits on some Medicare Advantage plans.

Does Medicare Pay for Vision Exams and Glasses?

Unfortunately, Original Medicare does not pay for vision exams or glasses in the majority of circumstances. However, there are some situations where Medicare Part B may cover an eye exam on an annual basis, most notably for beneficiaries who are diabetic with high risk for glaucoma. 

How Do I Get Vision Coverage with Medicare?

There are a few different ways in order to obtain vision coverage when enrolled in Medicare:

  • Stand-alone vision insurance plans (typically combined with dental coverage)
  • Vision discount plans (typically combined with dental coverage)
  • Medicare Advantage plans with included vision benefits

What Vision Services does Original Medicare cover?

Original Medicare does not cover routine vision exams but will provide coverage under certain circumstances. For example, Original Medicare will pay if:

  • Your vision condition is considered a medical emergency or traumatic injury, and you are admitted into the hospital.
  • You need cataract surgery, or had cataract surgery and need vision correction, such as glasses or contact lenses.
  • You are at high risk or have a family history of glaucoma. In this case, Medicare Part B will cover a yearly glaucoma screening.
  • You need a vision exam to check for diabetic retinopathy.
  • You have eye prosthesis due to a birth defect, trauma, or surgical removal. 
  • You need ocular photodynamic therapy.
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What Vision Coverage do Medicare Advantage Plans Include?

Certain vision services can be covered by Medicare Advantage Plans, but make sure to ask your plan provider which services will be covered, for each plan may be different. It would be best if you also asked your vision provider to confirm which plans are accepted.

Take note that the more coverage a plan offers, the higher your premiums, coinsurance, and copayments could be.

How Do I Get Vision Coverage with Medicare?

Although Original Medicare does not provide routine vision coverage, there are still options available to help with the cost of vision services including eye exams, glasses, and contacts. If you remain with Original Medicare and a Medigap plan, typically you will look at two options for additional vision coverage:

  • Vision Insurance: Vision insurance plans are plans that enrollees pay a monthly premium toward for a certain specified benefit amount for the year. Typically, vision insurance plans are in conjunction with dental and sometimes hearing coverage. Some vision plans may also have a deductible. 
  • Vision Discount Plan: Vision discount plans are typically paid as an annual fee, rather than a monthly premium. Typically, vision discount plans are in conjunction with dental plans. These plans work off of pre-negotiated rates with in-network providers, and do not provide reimbursement to the vision provider’s office. Essentially, these plans offer discounted rates on vision services. 

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Give us a call at 877-88KEITH (53484), an experienced agent will walk you through the different vision coverage options available to you.

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