UnitedHealthcare Medicare Advantage plans typically include coverage for vision care, such as routine eye exams and prescription glasses or contact lenses. There may be some out-of-pocket costs to consider.
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Regular vision care helps prevent common eye diseases, including cataracts, diabetic retinopathy, and glaucoma, from causing permanent vision problems. The ability to see clearly is important for well-being.
This article explores the vision coverage that UnitedHealthcare (UHC) Medicare Advantage plans provide and 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 coverage does not extend to routine vision care. Usually, it covers the diagnosis and treatment of eye diseases and injuries but does not cover routine exams or eyewear.
UHC Medicare Advantage plans offer vision and eye benefits that vary depending on plan type and a person’s location.
If an individual would like to join a UHC Medicare Advantage plan, they can choose from several types of plans:
- Health Maintenance Organization (HMO) plans
- Health Maintenance Organization Point-of-Service (HMO-POS) plans
- Preferred Provider Organization (PPO) plans
- Special Needs Plans (SNPs)
Vision coverage may include:
- annual routine eye examination
- allowance for eyeglass frames and prescription lenses
- contact lenses
- glaucoma screenings
- yearly diabetic retinal exams
- cataract surgery
Not all plans are available in all areas. To find UHC plans in a particular area, a person can search by their zip code in the UHC plan finder.
Alternatively, the Medicare plan finder tool will provide options, costs, and the plan providers’ contact information for all of the available plans in a person’s zip code.
For people with diabetes, original Medicare Part B covers an annual eye exam for diabetic retinopathy. It also covers glaucoma screenings for high risk individuals.
When someone joins a UHC Medicare Advantage plan, they must pay certain costs, including both the Medicare Part B premium of $148.50 and the UHC monthly premium. If applicable, people must also pay a Medicare Part A premium of up to $471.
Deductibles, copayments, and coinsurance are also payable, but these costs differ by plan.
For example, for a person living in zip code 90210, Los Angeles, CA, the 2021 costs of the AARP Medicare Advantage SecureHorizons Focus (HMO) plan are:
- $0 monthly premium
- $0 deductible
- $0 physician and $0 specialist copay
- $1,000 out-of-pocket maximum
Vision benefits and costs on this plan include:
- one eye exam per year with a $0 copayment
- up to $300 for frames or contact lenses every 2 years with a $0 copayment
- full coverage for standard single, bifocal, trifocal, or progressive lenses
Comprehensive eye exams are the cornerstone of eye care. Having regular eyesight tests to check for vision and eye conditions allows an eye doctor to catch signs and symptoms at an early stage.
The eye doctor can perform a vision exam with the pupil undilated or dilated. This exam may involve a range of tests, including:
- a visual acuity test to determine how well someone can read an eye chart from 20 feet away
- gonioscopy, which uses a mirrored lens to examine the eye’s drainage angle
- a visual field test, which measures peripheral vision and can indicate glaucoma risk
- tonometry to measure the eye’s internal pressure, which can show glaucoma
- a dilation test, in which the eye doctor uses medicated eye drops to increase the pupil’s size, allowing them to look at the back of the eye to see the retina, macula, and optic nerve
Dilation tests are particularly critical in
- diabetic retinopathy
- macular degeneration
- ocular tumors
If a person needs vision correction, the eye doctor may carry out a refraction test, in which they use different strength lenses to determine what prescription someone needs for clear vision.
Other vision services that someone might need include:
- cataract surgery
- eye prostheses
- ocular photodynamic therapy, for people with macular degeneration
- medications for infections or allergies that affect the eyes
UHC Medicare Advantage plans offer coverage beyond original Medicare, in addition to their vision services. Each plan provides different benefits, but these may include:
- prescription drug coverage
- dental coverage
- hearing coverage
- online cognitive health program
- Renew Active fitness program
By reading the details of different plans, a person can be confident in selecting the plan that best suits their healthcare needs.
Medicaid and Medigap may help someone pay their healthcare costs.
People with limited resources and income may find help through this joint state and federal program. Each state administers its Medicaid program differently, but they all use criteria that include a household’s income and assets.
Instead of Medicare Advantage, if an individual has original Medicare, they may prefer to enroll in Medigap supplementary health insurance. This helps pay out-of-pocket expenses that original Medicare does not cover, such as copayments, deductibles, and coinsurance.
The plans cover the costs associated with cataract surgery and serious vision problems, but Medigap does not cover the routine costs of eye exams, eyeglasses, and contact lenses.
Medigap plans also commonly cover emergency medical treatment outside of the U.S.
UnitedHealthcare Medicare Advantage plans usually cover vision and eye care services.
Depending on which plan a person chooses, coverage may be the same as original Medicare or include comprehensive cover for eyewear and routine eye examinations.
A person can use Medicare’s plan finder tool to see the Medicare Advantage plans that UnitedHealthcare and other private insurers offer in their area.