Understanding Medicare Advantage Vision Benefits

Knowing what Medicare vision care benefits you have and don’t have is important for your health. Vision care is not only about getting a good pair of eyeglasses. It is about preventing or managing eye conditions that could lead to vision loss. This allows you to perform your activities of daily living, and, most importantly, it keeps you safe.

Multiple studies have shown that older adults with vision impairments are more likely to have falls than their peers with normal vision. It has also been shown that older adults with vision impairments are at greater risk for hospitalization.

As many as 12 million people over the age of 40 have some type of vision impairment. Another 93 million are at high risk for vision loss. These vision conditions can be due to normal aging, but different eye conditions can also cause them.

This article will address what Medicare does and does not cover when it comes to eye health. You deserve to know how much you can expect to pay for care.

Woman selecting eyeglasses with her Medicare Advantage vision benefits

ljubaphoto / E+ / Getty Images

Summary of Original Medicare vs. Medicare Advantage 

Original Medicare includes Medicare Part A and Part B. They are referred to as “original” because they were the first parts of Medicare that came into law back in 1965.

Original Medicare provides vision care for medical conditions that affect the eyes. This includes cataracts (clouding of the lens) and macular degeneration (causes central vision loss).

People with diabetes who are at risk for retinopathy (damage to the light-sensing retina) or people at risk for glaucoma (damage to the optic nerve) also qualify for screening exams to diagnose and treat those conditions.

Unfortunately, Original Medicare does not cover routine eye exams or corrective lenses (contacts and eyeglasses). There is one exception to this rule: One pair of corrective lenses will be covered after you have cataract surgery. If those eyeglasses break or your prescription changes over time, you will have to pay for their replacements on your own.

Part C, also known as Medicare Advantage, is an alternative to Original Medicare. These plans are run by private insurance companies and cover everything Original Medicare does. The “advantage” is that they have the option to add supplemental benefits, which are extra services that Original Medicare does not cover.

Most Medicare Advantage plans offer expanded vision coverage, but you will need to look closely at your plan’s benefits to determine what types of services are included.

Deciding what kind of Medicare you want is an important decision. You could be enticed by the added vision benefits of a Medicare Advantage plan, but you could lose out on the many benefits of Original Medicare in the process.

For example, you can see any doctor that takes Medicare nationwide when you are on Original Medicare but you are limited to a local network of providers when you are on Medicare Advantage.

There are significant cost differences too. People on Original Medicare can sign up for a Medicare supplement plan, also known as Medigap, to pay for many out-of-pocket costs, or they could qualify for Medicare Savings Programs that also pay their premiums.

Your Medicare Choice

You have to decide whether you want to be on Original Medicare or a Medicare Advantage plan. You cannot be on both. If you are interested in a Medicare Supplement Plan, also known as a Medigap plan, you must be on Original Medicare.

These plans will help you pay your Part A and Part B deductibles (the amount you pay before Medicare begins to cover medical expenses), coinsurance (a percentage of the cost of a service), and co-payments (a set amount for a service) and can help keep your out-of-pocket expenses down.

List of Possible Vision Services Under Medicare Advantage 

Like Original Medicare, Medicare Advantage covers vision care for people with certain diagnosed medical conditions, people at high risk for certain eye disorders, and people who have concerning symptoms requiring evaluation.

This coverage may include office visits, tests, and even certain surgeries, including:

  • Cataract surgery
  • Glaucoma surgery
  • Macular degeneration treatments

It also covers certain retinopathy procedures, including:

What is covered beyond that is what draws people to Medicare Advantage. In 2021, as many as 99% of Medicare Advantage plans offered coverage for routine eye exams and eyeglasses.

That said, most of these plans have a cap on how much they will pay toward eye care, what kinds of eyewear you can get, and how often certain services can be used, including:

  • Contact lenses: You will want to find out if your plan covers contact lenses. If it doesn't, find out if it is limited to conventional contacts or if it also covers disposable lenses.
  • Eyeglass lenses: Depending on your needs, you will want to find out if your plan offers only standard eyeglass lenses or if they also include coverage for bifocal, trifocal, or progressive lenses.
  • Eyeglass frames: Some plans will let you choose from a limited number of basic frames to keep costs down. You may want to find out if your plan will pay for part of the cost if you upgrade to another type of frame.
  • Fitting exams for contacts or glasses: You should not get contacts or glasses if you do not try them on first. You need to understand how to insert and take care of contact lenses, at least the first time you get them. Likewise, it is important to make sure eyeglasses fit properly, so they are secure and don't hurt your face or ears.
  • Replacement lenses and frames: Not all plans will allow you to get more than one pair of glasses per year. You will want to find out how often you can get a new pair, especially if your current glasses break.
  • Routine eye exams: These exams screen people who do not already have a preexisting eye disease, are at high risk for eye disease, or have symptoms. You will want to find out how comprehensive these exams are. Most routine eye exams are performed after dilating the pupils and include checking for cataracts, color blindness, ocular pressure, retinal problems, and visual acuity (how well you see).
  • Surgery: Original Medicare does not cover laser-assisted in situ keratomileusis (LASIK), but some Medicare Advantage plans may cover it if your healthcare provider confirms that it is medically necessary.

Estimated Costs

Part A pays toward care you receive when you are an inpatient in a hospital. It also covers hospice care and home health services. You will pay a Part A deductible for each benefit period. In 2022, that deductible was $1,556 and covered the first 60 days of hospital care. Part A is unlikely to pay for eye care unless it was the reason for your hospital stay.

Part B pays for care you receive outside of the hospital or for hospital care that is under observation. It also pays healthcare provider fees both in and out of the hospital. You will pay a 20% Part B coinsurance for each service. The large majority of the time, vision coverage falls under the Part B benefit.

Medicare Advantage is run by private insurance companies rather than the federal government. For that reason, what you pay will vary based on the insurance company and your specific plan.

Despite many Medicare Advantage plans adding vision coverage in recent years, it is still not affordable for everyone. In 2019, as many as 6% of people on Medicare Advantage plans said they could not get vision care, and 66% of those said it was due to cost.

Again, it is important to weigh the differences in what you would pay for care based on the type of Medicare you sign up for. Vision care could be less expensive on Medicare Advantage, but other healthcare costs could be higher.

On average, people on Original Medicare pay less in out-of-pocket costs, including premiums, than they would spend on the maximum out-of-pocket limit for a Medicare Advantage plan, which does not include the cost of premiums.

Average Out-of-Pocket Costs for Corrective Lenses

According to the FAIR Health Consumer estimating tool, the average cost for contact lenses without insurance is $142 to $248 per lens. For eyeglass frames, it was $215 to $225. For eyeglass lenses, it cost approximately $38 to $137 per lens, depending on the type of lens.

These rates were estimated using a Chicago zip code. You can use the FAIR Health Consumer tool to find rates in your area.

Financial Assistance and Beneficiary Resources 

When your vision care is not covered by insurance (Medicare or otherwise), you may need to consider other ways to save.

Charitable organizations: Some organizations may be able to help, including:

  • EyeCare America is a program offered through the American Academy of Ophthalmology that offers free vision exams to people over age 65 if they qualify. Keep in mind that although the program covers an exam, it does not cover corrective lenses.
  • Lions Club International may have local offices that can provide free or low-cost eye exams and glasses in your area.
  • New Eyes is a nonprofit organization that provides free prescription glasses to people who have low income. You must meet financial requirements to participate.

Coupons and vouchers: You may be able to find online discounts for vision care from sites like Groupon and Living Social. You may also be interested in the following sources:

  • AARP membership may give you access to discounts at several retail clinics through EyeMed.
  • Coast to Coast Vision, a program from the Federation of American Consumers and Travelers (FACT), offers discounts for eye exams and corrective lenses.
  • OneSight offers a voucher program to people with low incomes.

Financing: You may be able to negotiate with your healthcare provider to pay for services in installments. You may need to pay this back with interest.

Optometry schools: If you are willing to let a student perform your exam, you may be able to get low-cost or even free vision care by reaching out to an optometry school near you. The online directory of the Association of Schools and Colleges of Optometry lists schools that might offer this service.

Retail clinics and stores: Discount clinics may provide less expensive vision services than you can get from a private office. Consider Costco, LensCrafters, Pearle Vision, Sam’s Club, Target, and Walmart as options.

Medicare Advantage Enrollment Window 

You can sign up for a Medicare Advantage plan when you first become eligible for Medicare. This Initial Enrollment Period happens when you turn 65. It starts three months before and ends three months after your birth month.

If you have a qualifying disability, you may be able to sign up for Medicare regardless of your age. You are eligible after being on Social Security Disability Insurance (SSDI) for 24 months. Benefits start sooner for people with amyotrophic lateral sclerosis (a disease that attacks the neurons that control muscles) or end-stage renal disease.

You also have the opportunity to change Medicare plans each year. The Medicare Open Enrollment Period, also called the Annual Enrollment Period, takes place from October 15 to December 7. During this period you can change from Original Medicare to a Medicare Advantage plan, or vice versa. You can also change from one Medicare Advantage plan to another Medicare Advantage plan.

If you find that the Medicare Advantage plan you chose is not the right one for you, you may be able to change it before the next Open Enrollment Period by utilizing the Medicare Advantage Enrollment Period from January 1 to March 31. This enrollment period is not available to people on Original Medicare.

Eye Health in Adults 65 and Up 

Regular eye exams are important. The American Academy of Ophthalmology recommends you get one every one to two years after 65.

There are other steps you can take every day to keep your eyes healthy, especially as you get older:

  • Decrease screen time: Staring at screens can strain the eyes and even cause a condition known as computer vision syndrome. When you use screens for a long period, try to look away for 20 seconds at something 20 feet away every 20 minutes to give your eyes a break. Better yet, step away from screens when you can.
  • Don’t smoke: People who smoke are at greater risk for cataracts and age-related macular degeneration. If you smoke, know that there are many resources to help you quit.
  • Drink water: Staying hydrated will prevent your eyes from getting too dry. Dry eyes can get red, irritated, and blurry.
  • Eat foods that support eye health. Foods rich in omega-3 fatty acids (e.g., oily fish like salmon and sardines), beta-carotene (e.g., orange foods like carrots and sweet potatoes), carotenoids (e.g., leafy dark green vegetables like kale and spinach), and zinc (e.g., legumes like beans and lentils) can all promote healthy eyes.
  • Manage your weight: People who are overweight or obese may be at greater risk for age-related macular degeneration, cataracts, and glaucoma. By increasing your risk of diabetes, excess weight increases your risk of diabetic retinopathy.
  • Stay active: Physical inactivity and lack of exercise may increase your chance of getting cataracts as you get older. If you are physically able, get moving.
  • Wear sunglasses: Ultraviolet (UV) light has been associated with higher rates of cataracts. Make sure you use sunglasses that protect against both UV-A and UV-B light.

Summary

Although Original Medicare covers diagnostic tests and treatments for certain medical conditions (e.g., cataracts, diabetic retinopathy, glaucoma, macular degeneration), it does not cover routine eye exams or corrective lenses, like contact lenses and eyeglasses.

This is why many people turn to Medicare Advantage plans that offer vision coverage as a supplemental benefit. Even so, coverage can still be limited so it is important to make sure any plan you choose meets your needs.

A Word From Verywell

Your vision changes as you get older. To prevent vision impairments and to maintain a good quality of life, it is important to take care of your eyes. Knowing what Medicare does and does not cover is the first step.

Frequently Asked Questions

  • Does Medicare Advantage cover eyeglasses?

    Most Medicare Advantage plans cover eyeglasses. However, the type of eyeglasses covered, how often you can get a new pair, and how much you will pay out of pocket will vary based on which plan you choose.

  • Where do you find information about Medicare vision coverage?

    Medicare.gov is a reliable source of information about services covered by Original Medicare. When it comes to Medicare Advantage, plans can vary. It is best to check with the insurance company that manages your plan for information about their vision coverage.

  • What would disqualify you from Medicare Advantage vision benefits?

    As long as you are eligible for Medicare, you can sign up for a Medicare Advantage plan with vision benefits. Because coverage varies among insurers, you will have to make sure that the services you need are covered by the plan you choose.

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