Medicare and Medicaid Vision Benefits
By Madeleine Vessel
Different kinds of vision care are included in Medicare and Medicaid programs that the U.S. government funds for those aged 65 and older,
individuals with specific disabilities, and people with low income.
To access vision services, you first need to understand what kind of Medicare and/or Medicaid plan you have and exactly what types of vision care
are associated with each particular plan.
Medicare: What Kinds of Vision Care Are Available?
Medicare's policy has four parts for qualified citizens who participate in the program, as well as access to supplemental insurance.
These aspects of Medicare coverage include:
- Part A, Hospital Insurance: This covers part of the costs incurred while in a hospital,
rehabilitation facility, or hospice. It also pays for some homecare costs. Vision problems that are
considered medical conditions, such as eye emergencies from trauma, would be covered here.
- Part B, Medical Insurance: This covers part of the costs of doctor visits and some other
medical services not included in Part A. Again, medical vision problems such as those related to
eye diseases would be covered in this section.
- Part C, Known as Medicare Advantage (MA): This gives Medicare participants enrolled in
parts A and B of the program the option of joining one of a variety of health plans (not available
in every area) that have contracted with the federal government to provide health care. Typically,
MA plans provide more benefits than Parts A and B. They also charge higher premiums. But these
premiums can include entitlement to extra vision benefits including at least some coverage for
routine eye exams, eyeglasses, or contact lenses.
- Part D, Coverage for Prescription Drugs: As with any medical condition, you likely would
qualify for coverage for eye diseases such as glaucoma
requiring eye drops to control internal (intraocular)
eye pressure.
- Medigap Policies: Individuals enrolled only in Medicare Parts A and B also can opt to
purchase a plan from among about 10 different Medigap insurance policies. Medigap is a supplemental
insurance policy that pays expenses not covered by Medicare Parts A and B. Members of Medicare Advantage
(MA) plans do not need to purchase Medigap because their policies already fill the gaps associated with
Medicare Parts A and B. Unlike Medicare Advantage (see Part C above), Medigap policies may cover medical
conditions such as eye diseases but do not include extra vision benefits for eye exams and artificial lenses.
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