Medicare Vision Benefits

Medicare is a federal health insurance program for qualified beneficiaries, most of whom are age 65 or older. It’s possible to receive Medicare benefits if you are under 65 and have certain disabilities or medical conditions.

While vision impairment is commonly understood to be an age-related health issue faced by older adults, Medicare’s vision benefits remain blurry. As a result, many seniors may consider enrolling in a Medicare Advantage plan that offers vision coverage in order to receive the eye care they need without having to pay fully out of pocket.

Let’s take a look at how vision is covered by Original Medicare and how a Medicare Advantage plan that offers vision coverage might be a good fit for some Medicare beneficiaries.

Doctor performing an eye exam

Medicare Part A vision coverage

Part A of Medicare is hospital insurance. As such, coverage for some of the costs of vision care is provided only in the event of a medical emergency or traumatic injury in which you were to be admitted to the hospital for inpatient care.

Medicare Part B vision coverage

Part B of Medicare is medical insurance, and it can offer a little bit more in the way of vision benefits.

Part B does not cover routine eye exams, eye refractions, glasses or contact lenses unless the vision correction is needed as a result of cataract surgery. Medicare Part B does, however, cover:

  • Annual glaucoma screenings, but only for those who are considered to be at a high risk (such as those with a family history of glaucoma, people with diabetes, African Americans aged 50 and older and Hispanics aged 65 and older)

  • Cataract surgery

  • An eye prosthesis when an eye is lost or damaged because of a birth defect, trauma or surgical removal

  • A yearly eye exam for diabetic retinopathy

  • Certain diagnostic tests and treatment for people who have age-related macular degeneration (AMD)

  • A simple vision test during your “Welcome to Medicare” preventive visit, which is only available during your first 12 months of having Medicare Part B

Medicare Advantage and vision benefits

By law, Medicare Advantage plans must provide at least the same coverage as Medicare Part A and Part B (with the exception of hospice care, which you continue to receive through Medicare Part A). Medicare Advantage plans may then offer additional benefits, as long as they are approved by Medicare. Among the most common additional benefits offered by some Medicare Advantage plans are coverage for vision and for prescription drugs.

According to Prevent Blindness America, half of all cases of blindness can be prevented through proactive measures. They also state that half of all people with glaucoma don’t even know that they have it.1

It’s easy to see why preventive measures such as routine eye exams and glaucoma screenings can be critical. In fact, the American Optometric Association recommends annual eye exams for everyone over the age of 60.2

Grandparents in a car with grandkids

Cost savings

Without proper coverage, a routine eye exam performed by a private optometrist costed close to $200 on average in 2018. Large retailers such as Walmart and Costco may offer a way to save some money on eye exams, but they still typically charge around $70 for an eye exam and up to $145 for an exam with a corrective lens fitting.3

Optical chain stores like the ones you might find in a mall may offer routine eye exams for between $73 and $89, and the cost can jump to between $113 and $159 when a corrective lens fitting is added.3

Glasses and contact lenses can come with a whole new set of additional expenses. The national average cost for a pair of eyeglasses for someone without vision insurance is $196.⁴

When you add it all up, the cost of an eye exam, fitting and a pair of glasses can easily exceed $300. If any prescription medications or eye drops are needed to help with your eyes, you could be responsible for those costs as well.

The average monthly premium paid for a Medicare Advantage plan in 2018 was around $35, or roughly $420 per year.5 When you consider the potential cost of eye exams, lens fittings, eyeglasses, contacts and any ocular prescription medications, it’s easy to see why a Medicare Advantage plan with vision and prescription drug coverage may prove beneficial to someone in need of such care.6

Shopping for Medicare Advantage plans

Contact a licensed insurance agent to get help finding a Medicare Advantage plan where you live. An agent can help you find a plan that may offer vision coverage. 

Call  TTY Users: 711 24 hours a day, 7 days a week to see a clearer picture of your vision care.

 

1 Prevent Blindness America. Prevent Blindness America: The Sight Saving People. Retrieved from https://www.preventblindness.org/sites/default/files/national/documents/fact_sheets/FS14_SightSavers.pdf.
2 American Optometric Association. Adult Vision: Over 60 Years of Age. Retrieved June 28,2018, from https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-over-60-years-of-age.
3 Meggitt, Jane. The Average Cost of an Eye Exam Without Insurance. Pocket Sense. April 11, 2018. Retrieved from https://pocketsense.com/the-average-cost-of-an-eye-exam-without-insurance-12393783.html.
4 CostHelper. How Much Do Eyeglasses Cost? Retrieved June 28, 2018, from http://health.costhelper.com/eyeglasses.html#extres1.
5 MedicareAdvantage.com’s internal analysis of CMS 2018 Medicare Advantage Landscape Source Files. May 2018.
6 The costs provided are estimated averages for 2018 and are not intended to illustrate known prices for vision care where you live. The services detailed could come with higher out-of-pocket costs than those listed.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.