Does Medicare Cover Glasses? It Depends on Your Plan
Navigate Medicare's complex rules for eyeglasses. Understand Original Medicare's limits, explore Medicare Advantage plans, and find other ways to cover your vision needs.
This article clarifies vision coverage under Medicare and explores alternative options for obtaining necessary eyewear. Understanding Medicare’s different parts and other available options is important for managing healthcare costs.
Original Medicare Coverage for Vision
Original Medicare (Part A and Part B) generally does not cover routine eye exams, eyeglasses, or contact lenses. Beneficiaries are typically responsible for the full cost of routine vision correction. However, Medicare Part B has a specific exception for corrective lenses following certain surgical procedures.
Medicare Part B covers one pair of eyeglasses with standard frames, or one set of contact lenses, after each cataract surgery that implants an intraocular lens. This coverage is for vision correction directly resulting from a covered surgical procedure, not for general refractive errors. After meeting the Part B deductible, beneficiaries typically pay 20% of the Medicare-approved amount. Part B also covers certain medically necessary eye care services, such as glaucoma screenings for those at high risk, or diagnostic tests and treatments for conditions like macular degeneration and diabetic retinopathy.
Medicare Advantage Plan Vision Benefits
Medicare Advantage Plans (Part C) are offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare covers, but often provide additional benefits, including routine vision care. Vision benefits commonly include routine eye exams, allowances for eyeglasses, and sometimes contact lenses.
The specific scope of vision coverage varies significantly between plans. Enrollees should review their plan’s Summary of Benefits to understand what is covered, including allowances for eyewear, network requirements, or associated copayments. For example, a plan might offer a yearly allowance for frames and lenses, or a fixed copayment for routine eye exams.
Other Vision Coverage Options
Beyond Medicare, other options exist for obtaining vision coverage or assistance with eyeglasses. Medicaid, a joint federal and state program, offers comprehensive vision benefits for eligible individuals, often including eye exams and eyeglasses. While federal law mandates vision coverage for children, adult coverage varies significantly by state.
Individuals can purchase standalone vision insurance plans from private carriers. These plans typically cover routine eye exams, provide allowances for eyeglass frames and lenses, or offer discounts on vision services. Such plans are designed to supplement existing health coverage that lacks routine vision benefits. It is important to note that Medicare Supplement Insurance (Medigap) plans generally do not cover routine vision care or eyeglasses, as they are designed to cover out-of-pocket costs for services that Original Medicare already covers.
Community programs and charitable organizations also provide assistance for eye care and eyeglasses. Various non-profit groups offer free or low-cost eye exams, provide vouchers for glasses, or facilitate access to donated eyewear for eligible individuals.