Ever wondered “Does Medicare Cover Contact Lenses?” You may want to think again, unless you meet a very specific set of circumstances. Assuming you’re already enrolled in Medicare Part A or Part B, the next set of requirements concerns whether or not you’ve had cataract surgery.
Medicare Part A does not cover routine vision care at all, including contact lenses, eyeglasses, or vision exams. Medicare Part B does cover one set of contacts or one pair of eyeglasses following a cataract procedure that implants an intraocular lens. Also, your contact lenses will be covered even if you had the cataract procedure before enrolling in Medicare. That said, it’s only a one-time allowance, so you can not use Medicare to update your contact prescription on an annual or biannual basis as most doctors recommend. Medicare will also cover contact lenses for both eyes, even if your cataract surgery was only for a single eye.
To qualify for coverage after cataract surgery
To get your contacts covered under Medicare Part B, you must have a prescription order signed by your optometrist or ophthalmologist on file with the provider of your contact lenses. The provider must be contracted with Medicare and must meet the standards necessary to qualify for a Medicare supplier number. If your contact lens provider does not have a Medicare supplier number, Medicare will not pay your claim.
Be sure to ask your doctor if he or she recommends diagnostic or examination services for contact lenses beyond what Medicare covers under Part B. If so, you will be responsible for 100% of those costs out of pocket.
After you’ve had your cataract surgery, you will have to pay 20% of the Medicare-approved amount for one set of contact lenses. You’ll also need to pay the Part B deductible. After those conditions are met, Medicare may pay the remaining 80% of the approved amount. Consult with your doctor or contact lens provider to determine the Medicare-approved coverage amount. You can review the coverage for contact lenses directly via Medicare’s official website or by phone at 1-800-633-4227.
You might also consider inquiring about Medicare Part C (also known as the Medicare Advantage Plan). Medicare Advantage plans are basically alternative coverage options issued by third-party insurance companies contracted with Medicare that may cover a wider variety of medical services than the standard Medicare Part A and Medicare Part B plans. Because there is a huge number of Medicare Advantage plans currently available, you will need to find which Medicare plan options include the vision and eyeglasses benefits that you need. We can connect you to a licensed insurance agent that will help you through that process.