Does Medicare Pay for Eyeglasses?
Medicare only covers eye care in specific situations. In order to receive covered prescription glasses and examinations, service provided through Medicare must be associated with chronic conditions and not just routine eye care. However, there are exceptions, depending on whether you have Medicare Part B or Part C.
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Eye Glasses Covered Under Part B of Medicare
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Medicare will pay for you to get new glasses or contacts if you have had cataract surgery in which the doctor replaced your intraocular lens. Medicare will also pay for the dark glasses that are worn immediately after surgery to protect your eyes, according to Medicare.gov.
Specific Types of Lenses Covered
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Medicare Part B will pay for one pair of clear, basic prescription eyeglasses or contacts after your cataract surgery. The plan may also pay for custom contacts or glasses post-surgery if they are determined to be medically necessary. This may include a special tint or special type of lens that is not normally considered basic. Your eye doctor can determine if your needs fall into the category of medically necessary specialty lenses.
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Other Medicare Plan Options for Glasses
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Medicare Part C, also referred to as Medicare Advantage, is a private insurance that is used in place of Part B. If you use Medicare Part C, you cannot enroll in Part B so your benefits will be different, according to Caring.com. Part C is basically an HMO policy that is managed care through Medicare and has different plan choices. Glasses may be one of the choices, depending on the options you choose.
Other Eye Care Services Covered by Medicare
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Even though Medicare Part B will not pay for routine eye exams, the plan does cover appointments to check for glaucoma, macular degeneration, cataracts and eye problems associated with diabetes. If you have vision problems that indicate a serious eye condition and after the exam nothing is found to be wrong, Medicare Part B will still pay for the examination.
Part B also will cover glaucoma screening once a year for people who are considered to be at high risk. To be considered in this category, you must either have a family history of glaucoma, diabetes, be African-American age 50 or older or Hispanic and age 65 or older.
Other Plan B treatments include therapy for macular degeneration, and eye prostheses under most circumstances. Glasses are not usually paid for after these covered procedures.
Considerations
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It is important that you understand which type of Medicare plan you have and your specific policies and billing procedures before scheduling an appointment with your eye doctor. Some services do require that you pay a deductible. To avoid costly bills, it is helpful to know in advance what portion of the cost you will have to pay for each type of service. Ask to speak with the billing or Medicare specialist at your eye doctor's office to clarify your potential out-of-pocket expenses.
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