New Medicare beneficiaries are often surprised to learn that Medicare does not cover routine vision services. For many people, glasses and or contacts become more of a necessity as we age.
Well, why wouldn’t Medicare cover this? The answer lies in our country’s history.
In 1965, Congress signed Medicare into law and back then, traditional health insurance coverage did not cover routine vision benefits. Initially health insurance did not view vision coverage as a necessary service. So, when Medicare was created it followed a similar suite of health insurance and did not include vision coverage.
Since the 1960’s, health insurance has evolved in our country. Most insurance companies routinely offer dental, vision, and hearing services to their members.
Unfortunately, Medicare has not made the same transition as they do not offer coverage for routine visits for any of those services that are considered necessary by today’s standards. When considering if Medicare will ever change this and add vision coverage it does not look too optimistic that Congress will pass measures to add it considering the funding issues with Medicare.
Since Medicare does not cover routine vision benefits, does Medicare cover any vision services at all? The key to everything that Medicare covers boils down to one question and that is, “Is it medically necessary?” If yes, then Medicare does provide Part B coverage for diseases and illnesses of your eyes. It would be no different than if it were a disease or ailment to any other body part. If you have glaucoma, macular degeneration, or cataracts, your visits to an ophthalmologist for these conditions will be covered just like any other Part B services. It is only the routine services that are not covered, such as an eye exam for the purpose of determining your vision so you can get new glasses or contact lenses.
Do not forget that your Part B does have an annual deductible, and that amount for 2023 is $226. After the deductible is satisfied, Medicare covers 80% and you are responsible for 20%. It is important to note that Medicare will only cover 80% of Medicare approved services. On approved service you could use a Medicare supplement plan to offset the 20% you are exposed to.
Another option is to sign up for a Medicare Advantage plan. Medicare Advantage plans work a little differently than original Medicare. The federal government allows these plans to include some extras, or ancillary benefits, in their plan designs. Some of the most common extras benefits we see in these plans are routine dental, vision, and hearing coverage. Each plan gets to decide how much it will offer for these benefits. We frequently see a vision benefit that provides an eye exam at which you will just pay a copay, anywhere from $0 – $50 for the exam. Other plans offer just the eye exam and no coverage for glasses or contacts. Others, however, may include a credit or reimbursement toward the cost of the eyeglasses. This benefit could be anywhere from $50 – $200 toward the cost of glasses or contacts every year or two years, depending on the plan. These plans vary from company-to-company and year-to-year. Be aware that Medicare Advantage plans change their benefits every year. The benefit that exists this year could be lowered, raised, or eliminated next year. If you enroll in one of these plans, make sure to utilize the benefits in case the benefit is eliminated next year.