Are you desperately in need of a new pair of glasses? Do you need a current prescription, or is it older than a year? If you need new glasses, or just an updated set of prescription lenses for your existing glasses, you may consider turning to Medicare for financial assistance. The only problem with that plan is that Medicare’s vision coverage leaves a lot to be desired.
Some Medicare plans don’t cover vision expenses at all, and those that do cover it typically place very specific restrictions on who is eligible and how much coverage they can receive. Medicare Part A enrollees receive no coverage, and thus will be responsible for paying for glasses, updated glasses prescriptions, and any associated doctor costs out of their own pocket. This can get pretty pricey, since the average person spends around $500 annually on eye exams and glasses.
Coverage after cataract surgery
Medicare Part B is similarly stingy. It does not cover eye exams, glasses, or glass prescriptions unless you need vision correction following cataract surgery. This coverage is limited to one pair of eyeglasses (or one pair of contacts), so you can not use it for annual glasses updates.
Post-cataract procedure services must be provided by a licensed optometrist. Medicare will only pay for standard frames, so those designer Gucci glasses won’t be covered. You will pay an additional cost for upgraded frames, so be sure and check with both your doctor and your glasses supplier to determine what qualifies as basic versus an upgraded frame. The good news is that eyeglasses will be covered even if you had your cataract surgery before enrolling in Medicare. Additionally, both eye lenses may be covered even if your cataract surgery was only on a single eye.
To receive your glasses following a cataract surgery, you must make sure that a prescription signed by your ophthalmologist or optometrist is sent to the provider who be making your glasses. The provider must be enrolled in Medicare. Medicare will not pay your claim if the provider doesn’t have a Medicare supplier number.
After you have paid the Medicare Part B deductible, you will need to pay 20% of the Medicare-approved amount for your new eyeglasses. Medicare will cover the remaining 80 percent.
Medicare Advantage plans might help
You may also want to inquire about Medicare Part C (also known as the Medicare Advantage Plan). Medicare Advantage plans are customized coverage options issued by third-party insurance companies. These are designed to cover a wider variety of medical services than the standard Medicare Part A and Medicare Part B plans. because there are so many Advantage plans currently available in the healthcare marketplace, it is important to select a Plan C option that includes the vision and eyeglasses benefits that you need. We can connect you with an insurance agent to help you navigate these options.