If you are covered by Medicare (or soon will be), you probably know Medicare’s vision coverage is strictly limited. Original Medicare only covers vision emergencies, like being admitted to a hospital with injuries to one or both eyes. Routine checkups, eyeglasses and more are not covered by Original Medicare. One exception is that if you are high-risk, Medicare Part B will cover glaucoma screenings. But are eyeglasses covered? Definitely not. Let’s go through what is and what is not covered so that you can make a choice that is right for your needs.
What Original Medicare Covers — and Doesn’t Cover
Government-provided Medicare (also called “Original Medicare”) consists of Part A (hospital coverage) and Part B (medical coverage). Medicare Part A is only intended to serve as hospital insurance for emergencies. This means if you are admitted to the hospital because of an accident involving your eyes, your plan benefits would apply; otherwise, you are responsible for all costs. What about Part B (medical coverage)? If you are considered high-risk for glaucoma, Medicare Part B does cover annual glaucoma screenings. These include those with diabetes or a family history of glaucoma, African-Americans over the age of 50 and Hispanics over the age of 65. Medicare Part B also covers cataract surgery, prosthetic eyes and special treatments for macular degeneration, but a 20% coinsurance cost typically applies to many of these treatments.
Beyond their Original Medicare, some individuals add a privately issued plan for more coverage, like a Medicare Supplement Plan (also called Medigap), or Part D (prescription drug plan). But Medigap does not include vision benefits, and Medicare Part D may only cover certain medicines for your eyes if prescribed by your doctor.
Much of this comes as a surprise to many — that while Part A and Part B include coverage for emergency situations or existing high-risk conditions, Original Medicare does not cover costs associated with important preventative measures. These include visits that can keep your eyes healthy, like routine vision screenings, prescription eyewear and eye exams.
What can you do? Many people choose between two options:
Vision Insurance Coverage Option 1: Medicare Part C
Medicare Part C plans are offered by private carriers and replace your Original Medicare coverage. Some of these plans (also called Medicare Advantage plans) include additional benefits, like vision coverage and more, but they are not required to have any benefits beyond those contained in Original Medicare. If you have a Part C plan, verify your coverage and make sure it is right for you.
Vision Insurance Coverage Option 2: Private Insurance Plan
To keep their coverage and costs simple to understand, many individuals with only Original Medicare choose to enroll in a private, individual vision insurance plan for coverage. This means they keep their regular government-provided plan, but add on the other benefits desired by choosing separate add-on plans. This could be vision only, or vision plus dental and beyond.
The benefits of a private plan can be appealing — you will choose exactly the coverage you’d like and you will know exactly what premium you’ll pay. If your vision coverage is rolled into a Medicare Advantage plan, it might be difficult to know if you are paying too much for each benefit.
Is Your Current Coverage Enough for Your Needs?
Perhaps you have only Original Medicare, or you have a Part C plan but your benefits are minimal or not even clear. It’s possible that individual vision insurance through a company like VSP is a better match for you. To help you make sure you have the best vision insurance, there are a few points to consider.
Great Vision Insurance for Medicare Has a Large Network
Vision health is so important, because over time, changes in your vision can show up that affect daily life. Great vision insurance for retirees will make it easy to get annual eye exams with a large network of eye doctors. VSP, for example, has the nation’s largest network of optometrists — more than 36,000 vision providers nationwide.
There’s a good chance that your eye doctor is already in our network or a new provider is conveniently nearby.
Annual eye exams can keep your vision correction up to date, but they also include important screenings for eye problems, like cataracts, macular degeneration and glaucoma. Eye exams can even detect high blood pressure and the early signs of diabetes.
Great Vision Insurance Reduces Out-of-Pocket Expenses
For those with Medicare who also need vision correction, great vision insurance will help to cover the cost of eyewear, lens enhancements or contact lenses without requiring a large premium. VSP Individual Vision Insurance plans, for example, start at just $13 a month.
Maybe you haven’t gotten your eyes checked in a bit and you know you probably need stronger correction. Our vision simulator can help you see what you’re missing, literally, with an outdated prescription.
But even if your prescription hasn’t changed, you may want to dabble in new eyeglass frames and styles to freshen up your look. The best vision insurance can help you reduce the cost of new frames, whatever the reason.
Ready to Find the Best Vision Insurance Plan for You?
Younger eyes might have seemed invincible, but our bodies change over time. While some changes are normal, maintaining good habits and getting the right kind of care from professionals is key to long-term health — and the right insurance can help. To get started, visit VSP to find a vision insurance plan that works best for you.
Your vision. Your way.
Not covered for vision? Get an individual plan, customized for you – including where you want to use it: at the doctor, in a retail location, or even online.
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