Vision can decline with age, due to certain health conditions, or because of trauma or injury. The eyes can develop disease or you may just notice a change in your vision as you get older. Many people who are diagnosed with a decline in vision turn to glasses or contact lenses to improve their sight. Medicare coverage may offer some vision care services, but cost and benefits may depend on your specific plan. Contact lenses are not always covered, but depending on your individual circumstances and specific Medicare plan, you may get help paying for them.
What are Contact Lenses?
Contacts serve as a corrective device that can solve chronic eye health issues. Many Medicare recipients are so active that contact lenses may offer them the flexibility that glasses do not. More and more individuals are wearing contacts, with the rate growing at around four percent each year.
Contact lenses are designed specifically for each eye based on the exact measurements and health of that eye. This means that your contact lenses may have two different prescriptions. Contact lens prescriptions can vary significantly, helping to address a range of vision issues including farsightedness, nearsightedness, astigmatism, monovision, and more.
These lenses work by helping your eyes to refract and focus light to improve vision clarity and depth perception, and they are placed directly on top of the cornea of the eye. Contacts are preferred over glasses by many because they are very portable and do not get in the way or interfere with various tasks throughout the day.
Contacts are available in many different types and styles, designed to work for specific eye health needs. Lenses vary significantly in the amount of time they can be worn. Some lenses are designed to be thrown away at the end of each day. Other contact lenses can be worn day after day for up to a month or more. These contacts vary in their material, and wearing them for multiple days requires careful cleaning.
Does Medicare Coverage Offer Vision Care Benefits?
Medicare Part A (Hospital Insurance) helps to cover care and services you receive when you are formally admitted into a hospital or skilled nursing facility, or are receiving home health services. Part B (Medical Insurance) covers medically necessary outpatient services and procedures to diagnose, treat, or prevent health issues. In most cases, eye exams and contact lens prescriptions are not included in Part A or Part B coverage.
To provide coverage, Medicare must deem a service to be medically necessary. If you need contacts simply to improve your vision, Medicare generally does not recognize it as medically necessary. Routine vision care is not usually included in Part A or Part B, but there are specific exceptions.
Some corrective vision procedures, such as surgery to correct chronic eye conditions like cataracts, are covered by Medicare. If you have undergone cataract surgery and you require the use of contact lenses following the operation, you may be covered by Medicare. During cataract surgery, an intraocular lens is placed in the eye. After surgery, contact lenses are required to ensure correct vision. Since the lenses are necessary in this case, Medicare will likely cover 80 percent of the Medicare-approved cost, leaving you to cover the other 20 percent in addition to your premiums. Coverage depends on if your physician accepts assignment.
If you require the use of contact lenses to improve your vision, or want help paying for routine vision care, Medicare Part C may be able to help. Medicare Advantage plans cover at least the same Part A and Part B benefits as Original Medicare, but many offer additional coverage, such as vision and dental services. MA plans can reduce your out-of-pocket costs for eye exams and any glasses or contact you may need. Compare plans available in your area to find the Medicare Advantage plan that is right for you.