Do seniors need private vision insurance to supplement the limited Medicare coverage? Probably not. It can be wise, though, to look at your options, especially if you’re retired and no longer enrolled on a vision insurance plan through your employer.
Medicare does not typically cover routine eye care. That lack of coverage means you’re likely to pay out of pocket for eyeglasses and contact lenses, and the routine eye exams needed to get your prescription.
Pros and cons of vision insurance for seniors
With private vision insurance, it’s possible to save money on glasses and frames. But choices are often more limited, and you’ll likely have to pay out of pocket for upgrades.
Network limitations can be a big disadvantage. If your eye doctor isn’t in the network, you’ll have to find a doctor who is in-network. That means getting that doctor up to speed on a lifetime of eye issues you may have experienced.
Is vision insurance for seniors worth the cost?
With Medicare’s limited vision coverage, you might consider buying a private vision plan. Coverage offered under private vision insurance also can be limited. You will still likely have to pay some out-of-pocket costs.
Save money by self-insuring
Based on this example, you could save money by self-insuring. Simply deposit an amount equal to the annual premium in a savings account and pay out-of-pocket for the exam and eyeglasses.
What vision services does Medicare cover?
Medicare Part A, hospital insurance, will cover treatment of eye conditions, such as a traumatic eye injury, when hospitalization is required.
Medicare Part B, medical insurance, covers 80 percent of the cost of outpatient surgery for certain eye conditions such as a detached retina and cataracts. Beneficiaries are responsible for the remaining 20 percent and the Part B deductible.
Part B also covers screenings that are medically necessary to diagnose and treat eye conditions.
Examples or Part B coverage may include:
- Cataract removal with limited coverage of eyeglasses or contact lenses after surgery
- Screenings for glaucoma and diabetic retinopathy
- Diagnosis and treatment of age-related macular degeneration (AMD)
- Retinal detachment (RD)
- Eye cancer
- A scratched eye
- Eye prostheses for those with absence or shrinkage of the eye due to birth defect, trauma or surgical removal
Medicare Advantage plans cover some vision benefits
Medicare Advantage, sometimes called Plan C, is an alternative way to get Medicare coverage through private vision insurance.
Medicare Advantage plans offer additional benefits that traditional Medicare does not cover. Limited vision coverage is one of the most commonly offered benefits.
More than eight out of 10 Medicare Advantage plans offer some type of vision benefits. These benefits can include a basic eye exam, contact lenses, eyeglass lenses and eyeglass frames.
Medigap plans offer vision benefits
Medicare Supplement plans, often called Medigap plans, also provide vision coverage or discounts. These vision plans are standardized by federal and state law.
Although vision coverage is not provided by standard Medigap plans, some insurers partner with an optometry group and offer discounts for vision services.
And in some states, Medigap insurers are allowed to add certain “new and innovative” benefits approved by the state, which can include vision benefits.
Read the fine print on your vision plan
Do your due diligence on any private or supplemental vision insurance plan.
Read the fine print and understand all of your potential benefits before visiting your eye doctor.
