Medicare’s coverage of vision services is based on treating specific conditions including cataracts, glaucoma, macular degeneration, and eye prosthesis. For cataracts, Medicare will cover the cost of surgery to implant an intraocular lens and either one pair of eyeglasses with standard frames or one set of contact lenses after the surgery. It’s important to understand that the supplier of the eyeglasses or contact lenses must be enrolled in Medicare, and it’s a good practice for you to check with the supplier prior to obtaining those items.
Glaucoma screenings are covered but only for individuals with a high risk of developing the disease. Those with high risk are defined as beneficiaries with a family history of glaucoma, African Americans age 50 and older, Hispanic Americans age 65 and older and individuals with diabetes.
Medicare provides coverage for macular degeneration including screenings, ocular photodynamic therapy with verteporfin and other outpatient prescription drugs.
Medicare Part B will also cover eye prosthesis due to birth defect, trauma to the eye, or surgical removal of the eye. It also covers polishing and resurfacing of the prosthetic twice per year, one enlargement or reduction in size per device and replacement of the prosthesis if it is lost, stole, or irreparably damaged in the first 5 years.
Medicare beneficiaries with funds in a Health Savings Account (HSA) or a Medical Savings account (MSA) can use them for vision services and eyewear.
Although not appropriate for everyone with Medicare, many Advantage Plans have additional coverage that includes vision, dental and fitness benefits. This should not be the sole reason for considering an Advantage Plan and you should always look at the totality of how a plan fits your specific needs before making changes to your Medicare coverage