Original Medicare, known as Medicare Part A and Part B, covers quite a few medical services. From preventive care to life-saving procedures, Medicare can help out. But unfortunately, this is not always the case when it comes to vision benefits.
We’ve compiled a list of the most frequently asked questions about vision benefits provided by Medicare Part A and Part B.
Does Medicare cover cataract surgery?
Yes, Original Medicare covers cataract surgery.
Technically, Medicare Part B covers the surgery as it is considered a medical necessity and is typically an outpatient procedure. However, you should always ask your doctor beforehand to see whether the operation will be inpatient or outpatient. Your coverage and costs will vary depending on the answer. 1
If you have a cataract, the procedure removes the cloudy lens and replaces it with a standard intraocular lens (IOL). Medicare Part B covers only this type of lens. However, since the lens is “monofocal” (meaning it just has a fixed focal point), folks often need glasses for seeing up close—when reading, for example.
This leads to another common question:
Does Medicare cover glasses or contact lenses?
Yes, but only if you’ve had cataract surgery in one or both eyes with an IOL implant.
Remember how people typically need reading glasses after an IOL implant? Medicare Part B understands this, and it will help cover a single pair of standard-frame glasses or contact lenses after your procedure. It doesn’t matter if you got the surgery before your Medicare coverage began or if you got the surgery for only one eye.2 You pay just 20% of the cost of the glasses after the deductible (if you have one).
It’s worth noting that Original Medicare will cover a pair of glasses or contact lenses only once. As soon as you’ve used the benefit, it’ll be gone. So use it wisely.
If you haven’t had cataract surgery and simply need reading glasses, Original Medicare won’t cover the cost. Several Medicare Advantage plans include vision benefits, though, which may provide coverage for glasses more frequently—sometimes up to once per year.
Does Medicare cover routine eye care services?
Generally, no, Original Medicare does not cover eye care. If you are looking for routine vision services, you’re better off looking into Medicare Advantage plans. These plans frequently cover vision benefits as well as everything covered by Medicare Part A and Part B.
There are exceptions, though. If you have Medicare Part B, it will cover specific vision care services, but only in certain situations:
- Age-related macular degeneration tests
- Regular eye exams—if you have diabetes or symptoms of eye disease
- Yearly glaucoma screenings—if you have diabetes, have a family history of glaucoma, or are African American and over 50 or Hispanic and over 65
If you don’t meet these conditions, however, you’re out of luck.
I’m a veteran. Does this change my vision care coverage?
It can! As a veteran, you can enroll in both Medicare and Veterans Affairs (VA) benefits. Although Medicare covers only Medicare-approved facilities and the VA covers only VA facilities, you might be able to get vision benefits from the VA that Medicare Part A or Part B doesn’t provide. That is, as long as you meet the criteria.
I want more vision benefits. What should I do?
If you need more vision services than Original Medicare offers, consider looking into a Medicare Advantage plan. You can also call one of our experienced agents who can find the right fit for your needs.
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