Original Medicare plans do not provide vision coverage. Due to this, Part A and Part B do not cover contact lenses, but some Medicare Advantage (Part C) plans may offer this benefit.
Original Medicare has many benefits, covering a range of services and treatments. Eyesight coverage is not currently included.
When a person requires corrective lenses, they may have to look for alternative plan options, and other Medicare plans may have some vision benefits.
In this article, we look at the coverage options for prescription contact lenses and eye care, as well as the situations in which Medicare may cover the costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare, parts A and B, do not cover the cost of contact lenses, eyeglasses, or routine eye exams.
If a person has a Medicare Advantage (Part C) plan, they can check with their plan provider to see whether it covers contact lenses.
As a person ages, they may experience variation in their vision, and older adults who have healthy eyes and sight may encounter changes.
Presbyopia can begin when a person is in their late 30s or early 40s. This means that it can be difficult to focus on things up close, and items or objects may appear to be blurry.
Some older adults may experience changes in visual acuity, such as:
- the eyes taking longer to focus and adjust to varied light conditions
- loss of contrast sensitivity, when it is not easy to distinguish between slight variations in tone and color
- increased light sensitivity that could make everyday activities, such as driving, more challenging
Rod cells are responsible for these visual challenges. The health of rod cells is partially dependent on environmental factors, such as:
- prolonged sun exposure
Medicare may cover some types of eye care, and where coverage is available, contact lenses or eyeglasses should be obtained from a Medicare-enrolled supplier only.
If a person is 65 or older, it is important to visit an ophthalmologist for an exam at least once every 2 years. The ophthalmologist will check for any age-related eye diseases.
According to the National Eye Institute (NEI), Black and Hispanic people over the age of 40 are at higher risk of developing glaucoma.
A person may also be at high risk for glaucoma due to diabetes or a family history of glaucoma.
Testing is available through Part B for glaucoma, and a 20% coinsurance applies, along with any outstanding deductible.
Diabetic retinopathy testing
If a person has diabetes, Medicare Part B may cover a yearly exam.
The exam must be performed by a Medicare-approved eye doctor who is legally allowed to conduct the test in the state.
Any remaining deductible and a 20% coinsurance will apply.
Macular degeneration testing
If a person has age-related macular degeneration, Medicare Part B may cover diagnostic tests and some injected prescription drugs for the treatment of the disease.
If an individual receives treatment in the hospital, the Part A copayment may be payable, along with the deductible.
Medicare Part B may help pay for corrective lenses if a person has cataract surgery to implant an intraocular lens.
Medicare-covered corrective lenses include one pair of eyeglasses with standard frames or one pair of contact lenses.
Out-of-pocket costs will be due, and there may be additional costs for upgraded frames.
Dilated eye exams
Eye doctors carry out dilated eye exams to check for a number of diseases, as well as checking a person’s vision.
The test is straightforward, pain-free, and the NEI consider it one of the best things for maintaining eye health.
For adults aged 60 and over, experts recommend that a dilated eye exam take place every 1–2 years.
In some instances, Part B will cover these tests, such as when the exam relates to diabetes care.
The NEI report on some measures that individuals can take to maintain healthy eyesight. These include:
- eating a balanced diet that includes fish that is high in omega-3 fatty acid and dark, leafy greens
- maintaining a moderate weight
- keeping diabetes under control
- wearing sunglasses and a hat with a brim when outdoors
The eyes require healthy blood circulation and oxygen intake, both of which are enhanced with regular exercise.
An older adult may try walking, yoga, or gentle stretching as an effective way to maintain physical health.
Over the course of a day, irritants can get into eyes, such as:
- dropped eyelashes
- chemicals from household products
- certain fragrances
As a person sleeps, their eyes are continuously lubricated, helping to soothe and restore the eye and remove irritants that have accumulated during the day.
Original Medicare does not cover the cost of contact lenses, eyeglasses, or routine eye exams.
A person can protect their eye health by doing regular exercise, getting plenty of sleep, and visiting their ophthalmologist and primary care doctor regularly.