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Enrolling in Medicare? What You Need to Know About Eye Exams, Glasses and Vision Care
Do you expect to be joining the ranks of Medicare recipients in the short term? Or are you looking to make changes to your current Medicare coverage during the open enrollment period from October 15 to December 7 each year? Is vision care a priority for you as you navigate Medicare waters? Whatever your questions and concerns, now is the time to get yourself educated on just what Medicare covers, what it doesn’t, and what your options are.
Before we get too deep into the weeds, however, let’s review basic Medicare coverage.
Typically, most people who become eligible for Medicare will receive their red, white and blue Medicare card in the mail about three months before their 65th birthday. Standard Medicare coverage includes Part A, which helps to cover the costs of in-patient hospital care, skilled nursing facility care, hospice care and home health care. Medicare Part A is typically available at no cost to enrollees.
Medicare Part B, on the other hand, assists with the costs of a wide range of medically necessary doctors’ costs, preventive services, screenings, mental health services, and outpatient services. It also covers durable medical equipment. It does not, however, include prescription drug coverage. Additionally, Unlike Part A, Medicare Part B is available at an additional monthly cost.
Here we’ll take the two out of order.
Medicare Part D is specifically for prescription drug coverage, and Medicare enrollees have the option of paying an additional monthly cost for this coverage. You can’t get Medicare Part D without having A and B, so this added cost is on top of the additional cost for Medicare Part B. A second option is to enroll in a Medicare Part C plan, also known as a Medicare Advantage Plan.
Medicare Advantage Plans are supplemental insurance plans that offer enrollees the opportunity to bundle their services. These plans are offered through private insurers and coverage varies between the policy selected, the insurers offering the plan, and from state to state. By law, they must include everything offered in Medicare Part A and B. In many (but not all) cases they may encompass the prescription coverage offered under Medicare Part D. They also may require participants use health care providers in their provider networks.
Some Medicare Advantage Plans come with a monthly fee, while others are offered with no upfront costs but with co-pays later at point of service. Depending on the provider, they may also offer a wide range of extras not covered under Medicare Parts A, B, or D such as dental, hearing aids, and vision care.
Vision care you say? So where does Medicare stand with that?
Medicare parts A and B do not cover routine eye exams, so the cost of a routine exam is totally the responsibility of the patient. Medicare also does not cover eye exams simply to determine a prescription. A few exceptions exist, such as if the Medicare recipient is receiving eye treatments while a patient is in a hospital or having eye surgery as a result of an injury.
Additionally, Medicare will cover eye exams to determine if the patient has certain medical conditions such as diabetic retinopathy, age-related macular degeneration, or glaucoma.
Medicare enrollees who desire to have vision coverage may want to opt for a Medicare Advantage Plan that includes vision coverage. Plans with vision coverage vary but are offered in all 50 states.
Medicare parts A and B do not cover prescription eyeglasses, with one notable exception. It does provide coverage for one pair of eyeglasses with standard frames or a set of contact lenses for patients who have had cataract surgery that includes the implant of an intraocular lens. Suppliers of the eyeglasses or contact lenses must be enrolled with Medicare.
In general, Medicare parts A and B will not cover routine eye care services. However, it will cover the costs to diagnose and treat more serious eye-related problems, including cataract surgery, diabetic retinopathy, macular degeneration, glaucoma, not to mention eye injuries. Additionally, while such conditions as dry eyes and allergies are not necessarily serious eye problems, they can impact vision, and Medicare will typically cover a diagnostic exam and prescription eye drops to treat the problem.
Medicare recipients who elect Part B coverage are entitled to a one-time “Welcome to Medicare” preventive visit and health assessment anytime during the first 12 months they have Medicare Part B. Enrollees may schedule this free visit with any healthcare provider that accepts assignment–meaning a health care provider who accepts the payment amount determined by Medicare as full-payment for the service.
Part of that preventive visit should include a basic vision exam, so if you’re new to Medicare, be sure to take advantage of that offer. It’s all part of getting a good baseline and education about preventive services to help keep you as healthy as possible during your senior years.
Disclaimer: MoneyMagpie is not a licensed financial advisor and therefore information found here including opinions, commentary, suggestions or strategies are for informational, entertainment or educational purposes only. This should not be considered as financial advice. Anyone thinking of investing should conduct their own due diligence.