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. Routine eye exams are not covered by Medicare — Part A.
• Part B, Medical Insurance: This covers part of the costs of doctor visits and some other medical services not included in Part A. Medical vision problems such as those related to eye diseases would be covered by this section, but not routine eye exams.
• 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.

More About Vision Benefits Offered Under Medicare, Parts A and B

Medicare policyholders enrolled in Parts A and B (the original Medicare program) are eligible for these types of vision coverage:

Glaucoma screening can be obtained once every 12 months for individuals with diabetes, with a family history of glaucoma, who are African-American over age 50, and who are Hispanics aged 65 and older. Glaucoma screening consists of a comprehensive eye exam, including dilation and intraocular pressure measurement.

Cataract surgery may be needed for one or both eyes, involving implantation of an intraocular lens that is an artificial replacement for your eye's natural crystalline lens. Medicare will cover the basic costs of lenses. But you also can choose personally to pay extra for the difference in cost for new multifocal intraocular lenses that can often restore your sight at all distances, meaning that you may no longer need to wear eyeglasses.

Eyeglass frames and lenses after cataract surgery, if necessary, may be covered under Medicare.

Artificial eye replacement also is listed among Medicare procedures eligible for coverage.

For more details about Medicare plans, call the Medicare hotline at 1-800-633-4227.

Page 2 of 3: Vision Benefits Under the Medicare Advantage (MA) Plan, Part C

Page 3 of 3: Medicaid and Vision Benefits

[Page updated April 2009]