Do Medicare Advantage Plans Cover Vision Care?

Today in the United States, one out of every three adults over the age of 65 have some level of vision loss or impairment, making it a major health care issue for the elderly.

If you’re 65 or older, you are at a higher risk for a vision-reducing disease like age-related macular degeneration, glaucoma, cataracts, and diabetic retinopathy. If you have one of these common vision problems, it can mean losing independence at home and being at an increased risk for conditions such as depression or social isolation. 

To protect yourself against vision loss, or to treat symptoms as soon as possible, you should take care of your health and have access to certain health care services. Having vision care coverage through your Medicare insurance can help you get the essential health care services.

Do Medicare Advantage Plans Cover Vision Care?

Routine vision care is essential for overall good health, well-being, and your independence. An annual eye exam gives your ophthalmologist and physician the ability to detect vision problems like astigmatism, nearsightedness, farsightedness, and other diseases like macular degeneration. These exams can also detect high blood pressure, diabetes, and other issues that may affect your general health.

Maintaining good vision by getting glasses, or updating corrective lenses when there are changes in eyesight can help you avoid accidents around the house, keep you safe while driving, and allow you to enjoy life more because you can see your environment better. And routine eye exams can prevent dangerous complications from health conditions like diabetes.

Unfortunately, Original Medicare Part A and Part B do not cover routine eye exams (eye refractions) and eyeglasses and beneficiaries pay 100 percent of the cost.

However, most Medicare Advantage (MA) plans do include coverage for these services as extra benefits. Because MA plan providers have the option to include extra benefits, you should check any plan you are considering enrolling in to ensure that routine vision care is included.

If you are enrolled in Medicare now, or if you’ll be eligible for Medicare soon, you should have information about what type of Medicare plan you need for vision care coverage.

Do Medicare Advantage (Part C) plans cover vision care?

Medicare Advantage (MA) plans, also known as Medicare Part C, are Medicare plans sold by private insurance companies that are Medicare-affiliated. U.S. federal law requires all MA plans to provide, at least, the same benefits that you would get from Original Medicare Part A (inpatient hospital insurance) and Part B (outpatient medical insurance).

Do Medicare Advantage (Part C) plans cover vision care?

Medicare Advantage (MA) plans, also known as Medicare Part C, are Medicare plans sold by private insurance companies that are Medicare-affiliated. U.S. federal law requires all MA plans to provide, at least, the same benefits that you would get from Original Medicare Part A (inpatient hospital insurance) and Part B (outpatient medical insurance).

Medicare Advantage plans that add routine vision care services to the coverage, typically include the following services:

• Routine eye exams
• Preventive eye exams
• Eyeglasses and/or contact lenses pairs up to plan limits
• Upgraded eyeglass frames

Your plan may restrict your eye exams to one time per year. Make sure you have the details before committing to a plan. Depending on your plan, you may also have an option for buying eyeglass frames from specific retailers like Warby Parker which are also available online.

How does Original Medicare cover vision care services?

Original Medicare Part A covers medically necessary procedures that require inpatient hospitalization. Original Medicare Part B covers cataract surgery and one pair of glasses or contacts following lens implantation procedures. Part B also covers periodic vision screenings for glaucoma and/or diabetic retinopathy for people who are in high risk categories. And Part B also covers diagnosis and treatment for macular degeneration.

If you currently have health care coverage with Medicare Part A and B, you have the following limited benefits for specific vision care services:

Eye exams for diabetics

If you are diabetic, Medicare Part B allows one eye exam per year for diabetic retinopathy. Your benefits cover 80 percent of the exam if the eye doctor is legally permitted to perform the exam in your service area. You are responsible for the remaining 20 percent of the Medicare-approved amount for the doctor’s visit. You are also responsible for your Part B deductible.

Glaucoma examinations

Medicare Part B covers glaucoma examinations once a year if you are at high risk. Medicare considers the following people to be at high risk for glaucoma:

• Diabetics
• Those with a family history of glaucoma
• African Americans over age 50
• Hispanics over 65

Medicare Part B benefits cover 80 percent of the Medicare-approved cost for the exam. You are responsible for the remaining 20 percent as well as your Part B deductible. If the exam is done in a hospital outpatient setting, you are also responsible for a copayment.

Testing and treatment for macular degeneration

Medicare Part B covers 80 percent of the costs for diagnostic tests and treatments, including those with certain injectable drugs, for eye disease if you have been diagnosed with age-related macular degeneration. Beneficiaries are responsible for the remaining 20 percent and Part B deductibles. If the testing or treatments take place in an outpatient hospital setting, you also pay a copayment.

How much do routine eye exams cost without insurance coverage?

Costs vary according to location, physician, and type of exam. But for routine refractive exams, prices typically range between $50.00 and $250.00. The national average cost for an eye exam is approximately $95.00. 

How Can Seniors Protect Their Eyesight?

Having Medicare insurance that offers routine vision care is a valuable asset for good eye health. Here’s a look at what you should be doing to ensure you keep your eyesight as strong as possible throughout your senior years:

• Get regular eye exams. It’s important to have your eyes checked on an annual basis, or more frequently if you have a health issue. Your ophthalmologist can diagnose diseases like age-related macular degeneration, cataracts, and glaucoma in the early stages. These eye checks can also help you treat or prevent vision loss and other complications caused by diabetes or hypertension.  
• Control and monitor your blood pressure, blood glucose, and cholesterol levels. Hypertension, diabetes, and arteriosclerosis are systemic diseases that increase your risk for vision loss, so keeping your levels under control is important.
• Wear prescription glasses if you need them to ensure better vision. Seeing better decreases your risk of falling or having an accident.  
• Wear sunglasses to protect your eyes from harmful ultraviolet sun rays. 
• Live a healthy lifestyle by incorporating healthy foods and exercise. 
• Don’t smoke! It’s a medical fact that smokers are at an increased risk for cataracts and macular degeneration.

If you have a Medicare Advantage plan, you can discuss your Medicare coverage of vision care services with a plan representative to ensure you have all the benefits you need.