What Vision Benefits Are Covered Through Medicare?

By: Thomas Wright
Published: Tuesday, October 30 2018
Last Updated: 16 days ago

Through Medicare parts, you are eligible to receive a wide range of vision benefits depending on the type of plan and coverage it offers. By default, Medicare doesn't cover routine eye exams like ACA vision benefits that cover for people age 17 and younger.

Medicare Part A Vision Benefits

Part A of the Medicare relates to hospital insurance. It covers Medicare vision care only in case of a medical emergency such as sudden vision loss or traumatic injury to the eyes. Medicare Part A, as mentioned earlier, doesn't cover routine exam or eye refraction. The insured individual must pay the full cost of the exam from out-of-pocket or pay through other vision plans.

Medicare Part B Vision Benefits

This part of the Medicare is medical insurance. Part B covers certain Medicare vision care but doesn't cover routine eye exam or refraction. It doesn't cover the cost of vision correction products such as eyeglasses or contact lenses unless the correction is needed after cataract surgery.

Medicare Part B will cover glaucoma screenings for insured individuals who are at high risk of glaucoma. These high risk individuals are people with family history of glaucoma, people with diabetes, Hispanic Americans age 65 and above, as well as African Americans age 50 and above. Only state-approved Medicare vision care providers are required to offer this service, and their cost is covered under part B. The insured individual pays 20% coinsurance after deductible for the costs approved by Medicare.

Medicare Part B will cover the cost of cataract surgery. It will cover the artificial lens cost that would be needed to replace the eye lens after surgery. The plan also covers the cost of vision correction items such as eyeglasses and contact lens. The insured individual pays 20% coinsurance after deductible for the costs approved by Medicare.

Medicare Part B will cover the cost of eye prostheses for insured individuals in case of the absence or shrinkage of the eye due to various causes such as birth defect, surgery or traumatic injury. This plan also covers the cost of resurfacing prostheses at least two times a year, as well as a single reduction or enlargement in the prosthesis size. Additional reductions or enlargements are covered if medically needed. The cost of vision prosthesis is covered in case if it's stolen, lost or damaged during the first five year period.

Lastly, Part B covers the treatment of vision problems associated with age, like macular degeneration.

How Often Is Vision Covered Under Part B?

Part B covers the cost of eye exam once a year for insured individuals at high risk for diabetic retinopathy. The exam should be supervised or done at a designated eye care provider who is in the network and legally allowed to conduct the test in the insured patient's state.

Part B covers the cost of glaucoma test once a year for insured individuals at high risk for glaucoma. The exam should be supervised or done by an eye doctor who is legally allowed to conduct the test in the insured patient's state. It also covers the cost of certain diagnostics and treatment of eye conditions, including treatment with injected drugs.

Who Is Eligible For Coverage?

  • Insured people with diabetes and of age 65 or above
  • Insured people at high risk for glaucoma, such as people with family history of glaucoma
  • African Americans age 50 or above and Hispanic Americans age 65 or above
  • Insured people with macular degeneration or AMD

Medicare Part C Vision Benefits

Medicare Part C is an alternative to receiving the Original Medicare parts benefits. Simply known as the Medicare Advantage plan, it is offered by private insurance companies that are Medicare-approved.

Under Medicare Part C, all insurers must offer the same benefits as Medicare Part A and B. Hospice care may be excluded as it is covered by Medicare Part A. Some of the benefits included in this plan are routine vision exam and prescription drug coverage. Medicare Advantage plans usually have higher premiums than other plans due to extended Medicare vision benefits. It offers full coverage of routine eye exam, vision correction items such as eyeglasses and contact lens as well as other eye care and treatments.

Medicare Part D Vision Benefits

Medicare Part D offers prescription drug coverage. Part D can be included while signing up for Medicare Part A and Part B (Original Medicare parts). The plan is usually offered by private insurance companies that are Medicare-approved. Medicare Part D or Medicare Advantage Prescription Drug plan covers vision care products, such as vision medications, eye drops and eye lubricants prescribed by an in-network eye care physician.