Medicare
Vision Coverage
Does Medicare Cover Vision?
The scope of your Medicare vision coverage will depend on the type of plan you have. As you age, so do your eyes. Regular vision exams are very important as you get older, especially if you are still driving or operating heavy machinery, since impaired vision can be a safety hazard. If vision is a health concern for you, be sure to carefully review the vision benefits included with a Medicare plan before enrolling.
What Are Your Vision Coverage Options with Medicare?
Original Medicare (Parts A and B)
Medicare Part A: Medicare Part A is primarily hospital coverage and does not cover your routine vision exams or eye refractions. Vision coverage is only available under Part A when your vision is considered an urgent medical issue, such as a traumatic injury or medical emergency requiring you go to the hospital.
Medicare Part B: Some of your vision care is covered by Medicare Part B, but routine vision exams are not. Unless you receive cataract surgery, vision correction (eyeglasses or contact lenses) is not covered. Eye refractions are also not covered under Medicare Part B.
Medicare Part B does cover:
- Yearly glaucoma screening for people at high risk (you must pay 20% of Medicare coinsurance)
- Cataract Surgery, including the cost of artificial lens as well as glasses with standard frames (you pay 20% of Medicare coinsurance for surgery)
- Eye Prostheses – the cost for vision prosthesis replacement if stolen, lost or damaged within first five years
- Ocular Photodynamic Therapy with Verteporfin
Medicare Part C (Medicare Advantage)
Medicare Advantage plans offer a range of vision benefits, from no additional vision coverage to fully covering exams, glasses, contact lenses, and more. Each plan’s coverage and costs will be detailed in its Summary of Benefits, a document you can review when researching plans and which a licensed insurance agent should carefully explain to you before enrolling you into a plan.
You can also check for your existing vision care providers in a plan’s network or have a licensed insurance agent look them up for you when you’re considering enrollment in a new plan. Choosing a provider in or out of network may significantly impact your costs, depending on the structure of the Medicare Advantage Plan.
You have a yearly opportunity to enroll in Medicare Advantage plans during the Annual Enrollment Period (AEP) from October 15 – December 7, so you may be able to find a plan with an increase or decrease in vision benefits for each year as needed.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans may help pay some of your costs from Medicare Parts A and B, such as copays, deductibles, and coinsurance for doctor visits, medical services or hospitalization. Medicare Supplement plans do not include any additional benefits beyond what is covered by Original Medicare.
Medicare Part D (Prescription Drugs)
Since Part D plans are strictly prescription drug coverage, certain products related to vision care (eye drops or eye medication) may be prescribed by your optometrist and covered by your Part D plan.
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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Last Updated: October 13, 2023 MULTIPLAN_ETQEZMwebsite_2024_M