Does Medicare Insurance Help Cover Contact Lenses?

Medicare Benefits Solutions
Feb 11, 2022

Your vision can start to decline as you age, and it can be due to injuries, trauma, or certain medical conditions. Your eyes can develop a disease, or you may just notice a vision change as you age. A lot of people who get diagnosed with this issue turn to contacts or eyeglasses to help improve their sight. 

Contact lenses can start at $150 a year and go up to $1,500 a year. The final cost will depend on the type and brand. Generally speaking, they cost between $20.00 and $30.00 a box. An eye exam usually costs between $150 and $200 without any insurance coverage.

Medicare coverage may extend to vision care, but the total benefits and costs will depend on your plan. Does Medicare cover contact Lenses? Not always, but depending on your specific Medicare plan and your circumstances, you could get assistance to cover the cost. 

Defining Contact Lenses

Contacts are a corrective device that can help solve chronic eye issues. Medicare recipients who are more active may like the fact that contact lenses give them the flexibility that you don’t get with glasses. Contact lenses are designed specifically for each eye, and the prescription gets based on the eye’s exact measurements. You could have two prescriptions for your contact lenses, and the prescriptions can vary significantly. Contact lenses can help address astigmatism, nearsightedness, farsightedness, monovision and more.

Contact lenses work by helping your eyes focus and refract the light to improve your depth perception and vision clarity, and they go directly on top of your cornea. Contacts are generally preferred over glasses because they won’t get in the way of daily tasks, and they’re very portable. You can also get them in several styles and types, depending on your eye health needs. 

Contact lenses also vary in how long you can wear them. Some lenses get designed to get thrown away at the end of every day, while others allow you to wear them day in and day out for a month or more. The material can vary, and wearing them for several days in a row requires special maintenance and cleaning. 

Medicare Coverage for Medically Necessary Contacts

When you have Original Medicare, Part A will help cover services and care you get when you get formally admitted into a skilled nursing facility, receive home health services, or you’re admitted into a hospital. Part B will cover medically necessary outpatient procedures and services used to treat, diagnose, or prevent health issues.

Usually, contacts and eye exams don’t have coverage under Part A or Part B. In order to get optometry services covered, Medicare has to deem the service or care “medically necessary.” If you require contacts to help improve your vision, Medicare usually doesn’t have this in the medically necessary category. Also, routine vision care isn’t generally covered by Part A or Part B, but there are exceptions. 

Contact Lenses After Cataract Surgery

Medicare will cover the cost of some corrective vision procedures, like surgery to correct a chronic eye condition like cataracts. If you’ve already had surgery to remove cataracts and you need corrective lenses after cataract surgery, Medicare may cover the cost.

During this surgery, the surgeon will place an intraocular lens in your eye. After the surgical procedure, you’ll need contact lenses to ensure your vision is correct. Since they’re medically necessary for this instance, Medicare will pay up to 80% of the Medicare-approved cost. You’ll have to pay for the remaining 20% and your premiums if your doctor accepts Medicare assignment. 

If you need contact lenses to improve your vision or routine vision care, Medicare Advantage Plans may be able to help. MA plans give you the same benefits you’ll get under Original Medicare, but many MA plans have extended coverage for services Original Medicare won’t pay for. Many offer coverage for dental and vision. Compare plans before enrolling to find the one that will give you all the coverage you need at a price you can afford.