Different types of vision care are included in the Medicare and Medicaid programs that the US government, Finances for eligible Americans and who are 65 or older, people with specific disabilities and people with low incomes.
To access vision services, you first need to understand what type of Medicare and / or Medicaid plan you have and exactly what types of vision care are associated with each particular plan.
Medicare Parts A, B and D: what is covered
Medicare has three parts that address different needs:
- Medicare Part A (hospital insurance). Medicare Part A helps pay the costs incurred while you are in a hospital or rehabilitation facility. It also covers the costs associated with home health care and hospice care. Medical eye problems that require emergency hospital care are covered, but routine eye exams are not covered.
- Medicare Part B (medical insurance). Medicare Part B covers part of the costs of doctor visits, as well as certain medical services not included in Part A, such as laboratory tests and medical equipment. Visits to an ophthalmologist who are related to eye diseases are often covered, but routine eye exams are not covered.
- Medicare Part D (Prescription Drug Coverage). Medicare Part D helps pay for the costs of prescription drugs, including medications for eye diseases, such as glaucoma.
Another way to get Medicare benefits is to enroll in a Medicare Advantage plan. These plans (also called Medicare Part C) are health plans managed by Medicare-approved private insurance companies that combine the benefits of Medicare Parts A and B, usually along with additional benefits such as Medicare prescription drug coverage ( Part D).
Medicare benefits for care and vision
Medicare Part B provides a number of vision and vision benefits. Keep in mind that there are premiums and deductibles associated with Medicare Part B.
According to Medicare.gov (the official US government website for Medicare):
- The standard premium for Medicare Part B in 2017 is $ 134 per month. Your monthly premium may be higher depending on your income, but most people who receive Social Security benefits will pay less than this amount ($ 109 per month, on average).
- The annual deductible for Medicare Part B in 2017 is $ 183. After spending this amount, you generally pay 20 percent of the Medicare-approved amount for most medical services, outpatient treatments, and durable medical equipment.
Here is a list of some of the Medicare vision care benefits:
- Cataract surgery Medicare covers many of the costs associated with cataract surgery, including the cost of a standard intraocular lens implant (IOL). If you choose a superior intraocular lens, such as an accommodative intraocular lens or a multifocal intraocular lens to reduce your need for reading glasses after surgery, you must pay the additional cost of the premium intraocular lens (above the cost of a standard intraocular lens ) out of pocket.
- Glasses after cataract surgery. Medicare helps pay for a pair of glasses or contact lenses after cataract surgery. Only standard glasses frames are covered.
- Glaucoma Screening Exam Medicare helps pay for the cost of an annual glaucoma test for people at high risk for glaucoma, including people with diabetes or a family history of glaucoma and African Americans 50 and older. The glaucoma screening test consists of a complete eye exam, which includes dilatation and measurement of intraocular pressure (IOP).
- Medicare eye prostheses help pay the costs associated with the replacement and maintenance of an artificial eye.
Medicare Supplement Insurance Policies (Medigap)
To extend coverage beyond what Medicare Parts A and B provide, eligible candidates can purchase a Medicare supplement insurance policy (also called a Medigap policy).
A Medigap policy is health insurance sold by private insurance companies to supplement (“fill in gaps”) in the coverage provided by Original Medicare (Parts A and B).
Medigap policies often cover their share of the costs of Medicare-covered services, including coinsurance, copayments and deductibles.
Some Medicare supplement policies also cover certain benefits that Original Medicare does not cover, including routine eye exams, glasses and contact lenses.
Medigap policies are intended to complement the coverage of Medicare Parts A and B only. Insurance companies generally cannot sell you a Medigap policy if you have a Medicare Advantage Plan (Part C) or if you are covered by Medicaid.