How to Get Better Medicare Vision Coverage

Medicare Benefits

Aug 29, 2021

If you’re not satisfied with your current plan’s vision care coverage, consider switching to a Medicare Advantage (MA) plan with more benefits, like routine eye tests, eyeglasses, and contact lenses. Switching plans now may save you money in the months and years ahead.

Medicare Advantage plans can vary in benefits and costs, so comparing the plans available in your area is a crucial step in finding a plan that meets your current needs. Since vision coverage can vary, you may find that some MA plans with higher monthly premiums cover more of the cost of eye exams and corrective lenses. Or that plans with lower monthly premiums require you to pay a higher copay and visit optometrists within the plan’s provider network.

Where to start

You should first take a look at what type of care and coverage is missing from your current Medicare plan’s coverage. Maybe you need additional help paying for routine eye exams or for your prescription glasses or contact lenses.

Because physicians recommend that adults over the age of 65 get their eyes checked every one to two years, having Medicare vision care coverage can be a valuable benefit. These annual exams are essential for the prevention and treatment of serious eye conditions that become more common as people age. Conditions like cataracts, glaucoma, macular degeneration, and diabetic eye disease can be caught early and treated more successfully when you get regular checkups.

Depending on where you live, routine vision checkups with an optometrist could cost between $75-$150. And if you need eyeglasses and/or contact lenses, your costs could be much higher.

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Vision care benefits with a Medicare Advantage plan

Medicare Advantage plans are sold by private insurance companies who choose to offer them. Most plans that do include vision care provide the following benefits:

  • Routine Medicare eye exams on an annual or semi-annual basis
  • Preventive eye exams
  • Prescription eyeglasses and/or contact lenses
  • Upgraded eyeglass frames – in some instances your plan may offer coverage for specific eyeglass retailers.

Because every Medicare Advantage plan is different, you should check the details of coverage carefully before enrolling to ensure you’re getting the Medicare vision coverage you need at a cost you can afford.

Depending on the plan you choose, it may cover 100 percent of your costs for Medicare vision tests and eyeglasses, or you may have to pay a portion of your costs as a copayment.

There are MA plans with coverage that allow you to buy any type of eyeglasses you want, including blended lenses or sunglasses. Other plans may only pay a portion of the cost, or just cover basic frames and lenses. If you’re spending a lot on eyewear every year, this benefit may be a big advantage for you.

Types of Medicare Advantage plans to choose from

There are several types of MA plans you may be able to choose from that vary in benefits and costs. In general, MA plans organized as HMOs (Health Maintenance Organizations) use specific network providers, suppliers, and facilities. To get your benefits for vision care, you must stick to the network providers. You may have to visit an optometrist within your plan’s network. HMO plans can be inconvenient for those who prefer doctors outside the network, but they tend to cost less than PPOs.

Currently have Original Medicare?

Original Medicare doesn’t usually include prescription lenses or routine Medicare eye exams with an optometrist.

Many Medicare recipients with Original Medicare Part A (hospital insurance) and Part B (medical insurance) end up buying their own vision care coverage outside of their Medicare insurance. This may provide some benefits, but it may add an extra expense you can’t afford. Having separate insurance plans can also seem daunting when bills arrive, and you may not be getting the coverage and benefits you deserve. Switching from Original Medicare to an MA plan can give you more benefits, including help paying for vision care, at little-to-no additional cost.

When can you change your Medicare plan?

When you find a Medicare plan with better vision coverage and you’re ready to enroll, you may be able to switch to the new plan during the following enrollment periods:

  • The Annual Election Period begins on October 15 and ends on December 7 annually. Your new coverage begins on the first of January.
  • The Medicare Advantage Open Enrollment Period begins annually on January 1 and continues until March 31. You can make one switch from one Medicare Advantage plan to another, or you can choose to go back to Original Medicare.
  • You may qualify for a Special Enrollment Period if you experience a certain life event, like moving out of your plan’s service area.

Importance of vision care

It’s vital to maintain good eyesight over the years by getting regular refraction eye exams. Having good eyesight can help you maintain independence, continue a high quality of life, drive safely, and to avoid accidents at home or outside. If you need a new pair of eyeglasses or contact lenses for sharper vision, having vision insurance may save you money.

As we age, it’s natural for healthcare needs to change. Because of these changes, it makes sense to review your current healthcare coverage every year to make sure you’re getting the most benefits for the amount of money you are spending. Ensuring that you have the best coverage for yourself means you don’t have to spend money out-of-pocket for something that could be included in your plan.

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