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Vision insurance & Medicare plans

At its basic level, vision insurance helps cover some of the cost of routine eye exams and eyewear. A few vision plans also pay for corrective procedures such as laser eye surgery. Additionally, plans may cover costs of one pair of glasses or contacts annually. Many Medicare Advantage plans offer two pathways to your vision coverage.


A little more information


Depending on the reason for an eyecare visit – a routine exam or a condition such as cataracts – it’s not always apparent which provider to use, and how their claim will be processed and paid. Medicare typically doesn't cover routine care, only comprehensive care; and only offers simple glasses post cataract surgery.


Routine vision exams whether given by optometrists or ophthalmologists may produce final diagnoses such as nearsightedness, farsightedness or astigmatism. During this exam, the optometrist or ophthalmologist might detect a problem related to diabetes or some other disease. The eye exam may produce a medical diagnosis such as conjunctivitis (pink eye), a common occurrence among children. Most insurance companies focus on the reason (diagnostic coding) for your visit, so health insurance probably would not cover a routine eye exam but, a follow up visit to your doctor because of a problem detected during a routine eye exam might very well be covered. Most health insurance covers a visit for an eye disease or eye injury.

It's no surprise that vision coverage is misunderstood by many people.


What in general, Does Vision Care Insurance Cover?


Vision care insurance usually covers a percentage of the following basic services:

  • Yearly eye examination
  • Eyeglass lenses
  • Eyeglass frames
  • Contact lenses
  • LASIK and PRK vision correction procedures at a discounted rate

Your specific vision care plan may have a limits, such as co-pays, deductibles, co-insurances, or how often it will pay for eyewear. This is the typical coverage we all enjoyed on our employer based health plans vision or other group coverage.

What about Medicare or Medicare Advantage plans?


Original Medicare only covers disease or degrading conditions to your eyes. If your not going blind from something other than old age, they're not covering it.


In some plans, there in no coverage; others you'll need use a certain eye care provider and receive a discount on the services where your eye care is managed by a contracted network of eye care providers. Still other plans, use an indemnity benefit format, simply reimbursing you a capped amount for allowed services.


Frequently, Medicare Advantage plans include limited vision benefits - as stated above, via distinct two pathways. Under your Part B benefits - disease or degrading conditions to the eye are covered, including injuries. These may have a co-pays or co-insurances depending on the condition and treatment. Separately, under the ancillary benefits of the plan, exams and eyewear may have limited or indemnity coverage reimbursing you for expenses up to a set dollar amount.


Typically, network eye care offices include optometrists and ophthalmologists. Some networks also may include ophthalmologists who perform refractive surgery, and provide LASIK or other vision correction procedures.

Do I Need EXTRA Vision Care Insurance?


Most clients find their vision benefits acceptable for periodic eye exams, and new eyewear every few years. Cataracts and Glacoma are affordably treated under most Medicare Advantage plans. As one customer stated, "they dont pay for everything, but I can afford the difference."

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