Your vision needs can change in an instant, whether that means getting glasses for the first time, or updating an old prescription. Knowing that you have coverage for the cost of eye exams, eyeglasses, or contact lenses can help you have peace of mind. What benefit does Medicare offer?
Are You Eligible for a Medicare Advantage Plan with Additional Benefits?
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Original Medicare Eyeglasses and Eye Exam Coverage
Medicare does not offer comprehensive coverage for hearing, dental or vision services. Regarding vision, Medicare Part A (hospital) will cover vision care that is considered an urgent or emergency medical issue. For example, an emergency in which you must visit the hospital.
Medicare Part B (medical) does not offer coverage for routine eye exams, eyeglasses or contact lenses, with the exception of lenses for cataract surgery.
Medicare Part B will cover:
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Glaucoma screenings (1 per year)
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Cataract surgery
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Eye prostheses
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Diabetic Retinopathy exams (1 per year)
You are responsible for the remaining 20% of the Medicare coinsurance for these covered Medicare services.
Medicare Advantage Coverage for Eyeglasses and Eye Exams
While Medicare Parts A and B offer some limited, specific vision benefits, if you are interested in coverage for eyeglasses, contact lenses, or eye exams you may find benefit in a different plan. Medicare Advantage (Part C) plans are offered through private insurance companies and cover all services that Medicare Parts A and B provide, with the addition of some benefits and/or savings. Medicare Advantage plans are known for providing coverage for vision, hearing, dental, prescription drugs and more in a single plan.
According to Kaiser Family Foundation (KFF), 99% of all Medicare Advantage plans offer coverage for eye exams and/ or eyeglasses. It’s important to note that each plan is different. While many plans offer coverage, the level of benefit offered will likely vary depending on the plan. Some plans may cover the full cost of glasses or contacts, while others may have a maximum limit of coverage per year. Understanding the nuances of the plans that are available to you will help you choose a plan that suits your healthcare needs and goals.
Frequently Asked Questions
No. Medicare doesn’t typically cover eyeglasses. You are responsible for 100% of the costs for non-covered services. Medicare Advantage (Part C) plans may offer vision benefits that cover the cost of eyeglasses.
Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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