Home Eye Glasses Medicare doesn’t pay for eyeglasses or contacts, and Medicare Advantage options have...

Medicare doesn’t pay for eyeglasses or contacts, and Medicare Advantage options have limits

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OriginalMedicaregenerally doesn’t pay for eyeglasses or contact lenses. You can obtain some vision care insurance throughMedicare Advantageor a private or group plan, but you should assess the value of such coverage before enrolling.

In most cases, as aMedicare Part Bbeneficiary you’ll pay 100% of the cost of contacts and eyeglasses, including frames and lenses.

There’s one exception: If you have cataract surgery, Medicare Part B will cover one set of corrective lenses if you need them after your intraocular lens is implanted. The Part B deductible, $203 in 2021, will apply, and you’ll owe a copayment of 20% of the Medicare-approved amount for vision correction. You must buy from a supplier enrolled in Medicare.

If you do want vision coverage, you may want to look at what locally available Medicare Advantage plans offer.

The good news is that 99% of Medicare Advantage enrollees find a plan with some vision coverage, according to the Kaiser Family Foundation. The bad news is that the average annual dollar limit for this coverage is $160, way less than the $366 average price tag for a pair of glasses with single-vision lenses.

The bottom line is that in 2018, the average Medicare Advantage beneficiary paid $194 out of pocket for vision services, which is only $48 less than the typical Original Medicare beneficiary spent, according to the KFF. Given this relatively small difference in out-of-pocket costs, it may not make sense to sign up for Medicare Advantage if vision care is the only benefit you need beyond what Original Medicare offers.

Individual or group vision insurance comes with similar questions about the value to the consumer. Typically requiring a monthly premium of around $15 or $20, vision plans that you buy on your own or through your or your spouse’s employer often have a host of limitations.

Here are some possible limitations of private vision insurance:

  • There’s likely a dollar limit on frames.
  • The plan may not pay for extras like lightweight or antiglare lenses.
  • You may not get coverage for both glasses and contacts in the same year.
  • When you enroll, there may be a waiting period of up to 30 days, or longer.

Are the limited benefits of private vision coverage worth the bother? Take a hard look before you enroll.

People who can’t pay out of pocket for corrective lenses can apply to the nonprofitNew Eyesfor a free pair of basic eyeglasses. Your application will need the support of a social service agency or other advocate.

John Rossheim writes for NerdWallet.



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