Generally, Medicare does not cover the cost of eyeglasses or contact lenses, although coverage for some items may be available after certain types of cataract surgery. Some Medicare Advantage plans also offer vision care.
Coverage for vision care may have associated costs, such as premiums, deductibles, copays, and coinsurance. Various programs are available to help with these costs, depending on a person’s circumstances.
Keep reading to learn more about Medicare and coverage for eyeglasses.
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.
Federally funded Medicare provides health insurance for older people in the United States. Some younger people with certain conditions or disabilities may also be eligible.
The program includes:
Coverage may be available for eyeglasses or corrective eyeglass lenses, depending on the Medicare plan.
Original Medicare (parts A and B) does not offer coverage for routine vision care, including eyeglasses, except in certain situations. Therefore, a person has to pay 100% of the costs.
However, Medicare coverage is available after a person has cataract surgery, as Medicare Part B will pay for corrective eyeglass lenses if the surgery included an intraocular lens implant.
The eyeglasses must have standard frames and come from a Medicare-enrolled supplier, as Medicare will not pay for designer frames. A person can upgrade their frames if they are willing to pay the additional costs over the medically approved amount.
While Medicare Advantage plans must offer the same coverage as original Medicare, they often include additional benefits, such as hearing, dental, and vision care. The latter coverage may include eye exams and eyeglasses, although there may be out-of-pocket costs.
Depending on the Advantage plan, a person may need to use in-network providers to get the best cost savings.
The coverage of eyeglasses may have several associated costs and conditions.
If a person gets coverage through Medicare Part B, they will need to meet the Medicare Part B annual deductible of $203 (in 2021), plus 20% of the Medicare-approved amount. They will also pay the Part B monthly premium, which is $148.50 in 2021.
The costs for Medicare Advantage plans vary depending on several factors, including the type and provider of the plan and the geographical area it covers. However, they may include a monthly premium, deductibles, copays, and coinsurance. In addition, plans generally have out-of-pocket costs — both in-network and out-of-network.
According to the Kaiser Family Foundation, Advantage premiums in 2019 averaged $29 a month. However, a person would also need to factor in the $148.50 monthly premium for Medicare Part B. In addition, a plan’s out-of-pocket costs generally have yearly limits, after which a person will not pay for covered services.
A person can use this online tool to search for plans and compare benefits and costs.
People may be able to get some help with the cost of eyeglasses and other vision care items. Possible options include:
- EyeCare America: This program is available through the American Academy of Ophthalmology, and it pays for a person’s eye exams with no out-of-pocket costs. People can contact EyeCare America at 877-887-6327.
- LensCrafters “Give the Gift of Sight” program: This program is available to nonprofit and social service groups that can apply on a person’s behalf for eyeglasses available through a local LensCrafters store.
- Lions Club: Local clubs may help people purchase eyeglasses or get eye exams. A person’s local chamber of commerce may provide more information, or a person can use this online tool.
- New Eyes: This group offers prescription glasses to children and adults, and people can contact them at 973-376-4903 for information. However, a person’s doctor or social service agency must apply to the group on their behalf.
- Prevent Blindness: The program provides vision screenings with a doctor’s referral. People can then call 800-331-2020 to find a participating location.
- Respectacle: People can search this online database of used eyeglasses to find a pair that matches their prescription. The nonprofit organization will then mail the eyeglasses to the person’s home address.
- Sight for Students: This VSP Global program helps children from families with low income to get glasses. A person will need to access the program through a school or another community partner.
Original Medicare (parts A and B) does not generally pay for eye exams or eyeglasses. However, Medicare Part B provides coverage for eyeglasses or contact lenses after cataract surgery when surgeons place an artificial lens in the eye.
People who are at high risk of glaucoma or have diabetes may have yearly preventive eye screenings. Some Medicare Advantage plans offer coverage for vision healthcare that may include exams and eyeglasses.