New Medicare beneficiaries are often surprised to learn that Medicare doesn’t cover routine vision services. After all, our eyes age throughout our lifetime. For many people, glasses or contacts become more of a necessity in our golden years.
Why in the world doesn’t Medicare cover this?
The answer lies buried in history. You see, Congress signed Medicare into law in 1965 and back then, insurance coverage itself did not routinely offer vision benefits. When health insurance as a concept grew in the 1950s, vision coverage was still not considered a necessary service. Therefore regular insurance coverage didn’t include it. Medicare followed suit.
Since then group health insurance has evolved in America. Now most companies routinely offer dental, vision and hearing services to their members. Unfortunately, Medicare hasn’t made the same transition. Considering the funding issues with Medicare, it’s not likely Congress will ever add it to Medicare.
So, what does Medicare cover on vision services at all? How can Medicare beneficiaries get coverage for routine vision services. Let’s review some options.
Medically-Necessary Vision Services
The key to everything that Medicare covers boils down to one question: is it medically necessary? If so, Medicare DOES provide Part B coverage for diseases and illnesses of your eyes just like it does for any other body part. If you have glaucoma or macular degeneration or cataracts, your visits to an ophthalmologist for these conditions will be covered just like any other Part B services.
Part B has a deductible of $183 per calendar year. After that, it covers 80% of your Part B services. This means that visits to your eye doctors for illnesses like those listed above or even for minor eye infections or pink eye will be covered. This Part B benefit will also provide a pair of eyeglasses after a cataract surgery. If you purchase a Medigap policy, it will also help to cover some or all of the other 20%.
It’s important to note that Medicare supplements cannot pay this 20%. Unless Medicare first approves your claim and pays its 80%, your supplement cannot pay either.
It’s only the routine services that are not covered, such as an eye exam for the purpose of determining your vision so you can get new glasses.
Fortunately, there are literally dozens of individual insurance plans that you can purchase at affordable prices that will help to cover your routine vision. Many of these plans are bundled with routine dental and/or hearing services since those also are not provided for by Medicare.
Here at our agency, we work with one such plan that covers dental, vision and hearing services. This policy has a couple of unique features that have made it very popular with our clients. It allows you to treat with your own doctor or dentist, and the plan just reimburses a percentage of the actual bill. The benefit also grows with time and has reduced waiting periods for some services.
There are dozens of other options sold on the private market as well that you can research online.
Limited Coverage Under Medicare Advantage Plans
Part C of Medicare possibly provides an option for some limited vision coverage. These Medicare Advantage plans pay instead of Medicare and are an alternative to Original Medicare. The federal government allows these plans to include some extras, or ancillary benefits, in their plan designs.
Some of the common extras we see in these plans are routine dental, vision and hearing coverage. The plan gets to decide how much it will offer for these benefits. We frequently see a vision benefit that provides an eye exam at which you will just pay a copay, anywhere from $0 – $50 for the exam. Some plans offer just the eye exam and no coverage for glasses or contacts. Others, however, may include a credit or reimbursement toward the cost of the eyeglasses. This benefit could be anywhere from $50 – $200 toward the cost of glasses or contacts every year or two years, depending on the plan.
You should be aware that Medicare Advantage plans change their benefits every year though. The benefit that exists this year could be lowered or eliminated next year. Be sure the use the benefit when you enroll in case the plan eliminates it the next year.
Paying Cash for Vision Care
Lastly, another way to save on routine vision expenses is simply to shop around. Call several providers and ask for the price of the eye exam. Find out if they will give you any discounts for paying in cash for your services since this saves the vision center the hassle of having to bill your insurance company. There are many reputable and caring vision providers who can provide care without breaking the bank.
Also, if you contributed to a health savings account before you retired and still have funds left in it, you can use those funds to pay for your vision expenses. The IRS consider these qualifed medical expenses, so you can use your HSA funds to pay for vision care.
Get Help with Vision Coverage
At Boomer Benefits, we understand the need for eye care during your retirement years. While Medicare itself doesn’t pay for routine eye exams or eyeglasses or contacts, there are a number of ways in which you can reduce your expenditure on these items. Reach out to us today and we can help you review your options.