Medicare does not generally cover either eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B (Medical Insurance) will help to pay for corrective lenses. This includes either one pair of eyeglasses or one set of contact lenses.
All individuals who are enrolled in Medicare Part B are covered for this benefit. It is important to note, however, that Medicare will only pay for eyeglasses or contact lenses that are provided by a supplier that is also enrolled in Medicare – regardless of who submits the claim (either you or your supplier).
When obtaining eyeglasses or contact lenses in this manner, the Medicare enrollee will be required to pay 20% of the Medicare approved amount for one pair of glasses or one set of contact lenses after each cataract surgery with an intraocular lens.
You may, however, be required to pay any additional costs if you purchase items such as upgraded eyeglass frames. You will also need to pay for 100% of any non-covered services. In addition, the Medicare Part B deductible will also apply. In 2015, the amount of the Medicare Part B deductible is $147.
In order to get a better idea of how much your items may cost, you should speak directly with your doctor or your other health care provider. This is because the specific amount that you will owe can depend on a number of different factors. These can include any other insurance coverage that you may have, the amount that your doctor and / or supplier charges, whether or not your doctor and / or supplier accepts Medicare assignment, the type of facility where you obtain your services, and the location where you get your test, items and / or services.
In addition, your doctor or other health care provider may recommend that you obtain your services or your items from a supplier that is not covered by Medicare. If this happens, your items will not be covered. Therefore, it is important to ask questions so that you understand why your doctor is recommending these certain items.
Although Original Medicare (Medicare Part A and Part B) offers limited coverage for eyeglasses and contact lenses, there is another potential option for obtaining these benefits. The way to do so would be to join a Medicare Advantage Plan (also referred to as Medicare Part C).
Many Medicare Advantage plans will offer coverage for vision related benefits, which may include eye exams, as well as coverage for eyeglass frames and lenses and for contact lenses. Medicare Advantage plans are offered via private insurance companies, and not by Medicare directly. Therefore, the plans can differ, and a deductible and / or a co-payment may or may not apply, depending on the specific Medicare Advantage plan that is chosen.
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