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Does Medicare Pay for Glasses? Learn What’s Covered & Your Other Options

ReachMD Healthcare Image
08/15/2023
finance.yahoo.com

As we age, our bodies tend to have more challenges. It’s likely that worsening vision is one of them. According to a 2018 JAMA Opthalmology study, 92% of Medicare beneficiaries wear glasses to correct near or distant vision, yet Medicare doesn’t cover eye exams to check for refractive errors, and it doesn’t cover most eyeglass lenses, frames, contact lenses, or contact lens fittings.

Medicare coverage for glasses

If you have cataract surgery that implants an intraocular lens, Medicare Part B will help pay for corrective lenses, which some people still need even after surgery.

Cataracts, or clouding of the eye’s natural lens, are a common condition of aging. Over time they can lead to blurred vision and other difficulty seeing. Medicare covers cataract surgery when your cataracts “cloud the vision to the point where it's interfering with activities of daily living,” says Dr. David B. Glasser, ophthalmologist, secretary for federal affairs at the American Academy of Ophthalmology, and faculty member at the Johns Hopkins Wilmer Eye Institute.

“When Medicare covers cataract surgery, it’s typically a monofocal lens implant,” he says. “That means that patients can choose if they’d rather see better at a distance or close up.” Other types of cataract surgery lenses that are not covered by Medicare include toric (for astigmatism) and multifocal, which can correct both near and distance vision. “With a monofocal lens implant, patients may still need to use glasses to correct astigmatism or to see up close or far away,” says Glasser.

If you need corrective lenses after cataract surgery, Medicare Part B covers 80% of one pair of eyeglasses with standard frames or one set of contact lenses after you meet the Part B deductible. You will be responsible for paying extra costs for upgraded frames, and Medicare will only cover contact lenses or eyeglasses from a supplier enrolled in Medicare.

Other coverage options for glasses

Medicare Advantage plans

If you’re looking to get insurance coverage for glasses, consider a Medicare Advantage plan.

According to KFF, 99% of Medicare Advantage enrollees had access to some vision coverage in 2021. Eye exams and eyewear (contacts and/or eyeglasses) were covered in 93% of the plans, but most coverage has an annual coverage limit averaging $160.

Most plans limit eye exams to once per year. Over half of enrollees can only get new glasses or contact lenses once a year or every two years.

Medigap and Medicaid plans

According to an analysis by The Commonwealth Fund, only a small amount of Medigap plans offer vision coverage. These Medicare Supplement plans may offer a bundle of coverage, including hearing, dental, and vision. Medicaid often covers eye exams and medically necessary corrective lenses, but coverage varies by state.

Low cost vision options

Several organizations offer low- or no-cost vision care, for those with a low income or other qualifiers. Many programs provide nationwide coverage, but there are also local organizations that offer assistance as well:

  • EyeCare America, offered by the Foundation of the American Academy of Ophthalmology, offers free eye exams and other services to those on a low income who qualify.

  • New Eyes provide vouchers to those with financial hardship who need new prescription eyeglasses.

  • Lions Club. Local chapters may offer financial assistance for glasses and eye exams. Use the club locator to contact a club.

This story was originally featured on Fortune.com

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Schedule24 Apr 2024