The lack of coverage for vision treatments is one of Medicare’s most common criticisms. It’s easy to assume Medicare would not cover anything related to eye health. But Medicare does cover certain eye treatments, just in a limited way.
What kinds of vision treatments does Medicare NOT cover?
Medicare only covers what it deems medically necessary. Routine eye exams, glasses, and contact lenses are not considered medically necessary.
LASIK eye surgery is also not considered medically necessary either because it’s an elective surgery.
However, if you would like this type of coverage, you may want to consider enrolling in Medicare Advantage. Medicare Advantage offers additional coverage for eye treatments that Original Medicare won’t cover. The treatments and services mentioned would be covered under Medicare Advantage.
What types of eye surgery does Medicare cover?
Original Medicare does not exclude vision health entirely. It will cover surgeries that prevent blindness, such as those used to treat:
- Age-related macular degeneration
- Detached retina
- Diabetic retinopathy
- Eye trauma
These surgeries are commonly outpatient procedures, meaning they’re covered under Medicare Part B. Your payments will include a copayment, deductible, and coinsurance.
How does Part B cover eye surgeries?
Once your deductible is met ($203 in 2021), Part B covers 80% of the bill. Your coinsurance cost will be 20% of the total, though it can be more in certain circumstances. A copayment also applies, which is an amount your plan determines ahead of time.
How can I get additional coverage?
If you are in an adverse financial situation and qualify for Medicaid, you can get a Medicare Advantage plan known as a Dual Eligible Special Needs Plan (D-SNP). This combines Medicaid and Medicare, which saves on premiums and deductibles as well as procedure costs.
If you have Original Medicare and want extra coverage for Medicare-covered eye surgeries, you can enroll in a Medicare Supplement (Medigap) plan to make out-of-pocket costs even lower. Medigap plans will offer additional coverage after Medicare Part B has paid its 80%.
Aside from Plans C and F, there are no Medigap plans that will cover the Part B deductible. These are only available to those who turned 65 before January 1, 2020.
All Medigap plans will cover the Part B coinsurance or copayment. Most cover the entirety of the remaining out-of-pocket costs, with the exceptions being Medigap Plans K and L. These cover the remaining 50% and 75% coinsurance or copayment costs, respectively.
If you want to get a Medigap plan, it is best to do so within six months of enrolling in Part B, as your insurer may deny you Medigap coverage if you choose to enroll at a later date.
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Turning 65 Solutions will help you get the most out of your Medicare plan by helping you find Medicare coverage that helps you save on your medical expenses. If you have any questions or concerns, don’t hesitate. Call us today at 830-217-6711.