If you’re enrolled in Medicare, routine vision care isn’t guaranteed. Some privately administered Medicare Advantage plans cover eyeglasses and eye exams. But Original Medicare — which provides health insurance to Continue Reading
If you’re enrolled in Medicare, routine vision care isn’t guaranteed.
Some privately administered Medicare Advantage plans cover eyeglasses and eye exams.
But Original Medicare — which provides health insurance to about 37.7 million Americans — doesn’t pay for your new eyeglass frames or an annual vision exam.
So how do you know, in your own case, what’s covered and what’s not?
Whether you’re new to Medicare and wondering what to expect at your next eye exam, or you’re a long-time beneficiary trying to save money on glasses, our guide to Medicare vision coverage and affordable eye care is here to help.
How Medicare Covers Vision
If you have a serious eye disease like cataracts or glaucoma, Medicare Part B will generally pay for treatment.
But that’s not the case for routine exams and eyeglasses.
Most private Medicare Advantage plans provide some coverage for glasses and routine vision tests. Original Medicare does not.
Here’s how it breaks down.
Original Medicare does not cover routine vision exams, eyeglasses or contact lenses. Lasik surgery isn’t covered either.
You’re on the hook for the full cost unless you have a separate private vision care policy or secondary insurance like Medicaid.
Original Medicare does cover eye care related to illness or injury, including cataract surgery and glaucoma screenings. More on that shortly.
Nearly all Medicare Advantage plans — which are administered by private insurance companies like United Healthcare and Cigna — include some routine vision coverage.
However, vision benefits are pretty modest — plans offer about $160 worth of eyewear and eye exam coverage a year on average, according to an analysis by the Kaiser Family Foundation (KFF).
Medicare Advantage plans also restrict the vision benefits they offer, including:
- how often you can replace glasses and/or contact lenses.
- how often the plan will pay for eye exams.
For example, 47% of Medicare Advantage plans limit beneficiaries to one pair of eyeglasses every two years, according to the KFF analysis.
Finally, to get these vision benefits, you will need to use certain eye care professionals and services within your specific Medicare Advantage plan network.
Medicare Coverage for Other Eye Treatments and Conditions
By law, both Original Medicare and Medicare Advantage must cover the same basic vision services for eye diseases and chronic conditions.
If you have an eye disease that causes low vision, such as macular degeneration or glaucoma, Medicare Part B will cover screening tests and standard treatment.
You’ll pay 20% of the Medicare-approved amount for these covered treatments and services after meeting your Part B deductible.
Medicare Part B covers 80% of the cost for:
- Certain treatments for serious eye conditions, including micro-invasive glaucoma surgery.
- Cataract surgery. Medicare will pay to implant a conventional intraocular lens. It will also cover one pair of standard-frame eyeglasses or a set of contact lenses after cataract surgery.
- Detached retina treatment.
- Treatment for certain dry eye conditions.
- Eye exam for people with diabetes to detect glaucoma and diabetic retinopathy.
- Annual glaucoma test for people at high-risk of developing the disease or with a family history of glaucoma.
- Some tests and treatments for age-related macular degeneration.
- An eye prosthesis (artificial eye) for patients with absence or shrinkage of an eye due to birth defect, injury or surgical removal.
The services above are covered whether you have Original Medicare or a Medicare Advantage plan.
Some diseases and conditions — such as lupus and shingles — can affect your vision even though they aren’t traditional eye diseases. Medicare Part B covers treatment for your eyes if you have one of the many conditions on this list from the U.S. Centers for Medicare & Medicaid Services.
How to Save Money on Vision Care Costs
Eyeglasses and routine vision exams are pricey for Original Medicare beneficiaries.
Fortunately, several programs and organizations offer free or discounted eyeglasses and exams for older adults.
Here are some of the best ways to reduce your out-of-pocket costs on routine vision care when you’re enrolled in Medicare.
How to Save Money on Eye Exams
The national average cost of a comprehensive eye exam is $95, according to All About Vision and other sources, but the figure can vary from $50 to $200.
Here are a few ways to keep more money in your pocket without forgoing important eye care.
Discounts for AAA and AARP Members
AAA and AARP members can receive discounts at participating LensCrafters and other retail locations nationwide.
Members of AAA and AARP can get the following discounts at LensCrafters:
- 30% off comprehensive eye exams.
- 50% off a complete pair of eyeglasses (frame and lenses) and prescription sunglasses. Valid in-store and online.
- 10% off disposable contact lenses.
- 30% off non-prescription sunglasses.
AARP members also receive these discounts through other providers:
- $55 comprehensive eye exam at participating independent eye doctors (Use this tool to find a location near you).
- $10 off best in-store offer on a complete eyewear purchase at Target Optical.
- 10% off contact lenses at Target Optical.
- $10 off non-prescription sunglasses at Target Optical.
- 30% off a complete pair of glasses at Glasses.com (Use code RP_30OFF_GL at check out).
To receive your AAA or AARP member discount, make sure to present your membership card at participating locations.
Costco and Walmart
Retailers like Costco and Walmart offer optical centers with affordable pricing on eye exams and glasses.
At Walmart, eye exams average about $65, but prices vary by location.
Like Walmart, Costco eye exam costs vary, but you can expect to pay anywhere from $50 to $100 for an exam.
Both retailers also offer a wide selection of eyeglasses in the $35 to $75 range.
EyeCare America is the public service arm of the American Academy of Ophthalmology.
Its Seniors Program provides comprehensive eye exams and up to one year of followup care for any eye condition diagnosed during the initial exam.
These services are free to qualifying older Americans. It’s one of the only national programs that offers free eye exams for people on Original Medicare.
To qualify for the EyeCare America Senior Program, you must:
- Be age 65 or older.
- Be a U.S. citizen or legal resident.
- Not belong to an HMO or have eye care benefits through the VA.
- Not have seen an ophthalmologist in three or more years.
Just a heads up: This program does not cover the cost of eyeglasses.
You can see if you qualify and apply for the program by filling out this form.
Lions Club International
The Lions Club can pay for eye care and eye exams at local club locations and community events. Some locations also provide eyeglasses.
For more information, reach out to your local Lions Club chapter.
Optometry Schools and Senior Discounts
Students at optometry schools sometimes provide free or discounted eye exams during clinics.
These undergraduates are closely supervised by faculty members, so it can be a cheap way to score a routine vision test.
You can use this tool to search for schools in your area — although the eye exams and care provided vary from school to school.
Another option is asking local vision care providers if they offer any senior discounts or in-house financing plans. Make sure to call ahead and ask before scheduling an appointment.
Older people with low incomes may also qualify for free or reduced eye exams at their local county health department.
Finally, numerous local nonprofits offer free eye exams throughout the year. Call United Way’s 211 service to see if a program exists near you. Or Google “free eye exams near me.”
Where to Get Free or Cheap Eyeglasses
Affordable eyeglass lenses and frames are easy to find online or at large retail stores like Walmart and Costco.
There is also a program that provides free eyeglasses to those who qualify — but be prepared to jump through some hoops first.
OneSight Vision Voucher Program
The OneSight Vision Voucher program helps people in need receive free eyewear if they’re not able to cover the cost of eyeglasses with insurance.
Here are the steps you need to take:
- Get a referral letter from a nonprofit organization verifying your visual and financial need for glasses. The letter must be written on company letterhead and include the Tax ID# of the nonprofit organization. Recommended nonprofits include churches, the Lions Club, Prevent Blindness, Red Cross and United Way.
- You’ll need a valid prescription from an eye doctor. If you don’t have a prescription that is less than two years old, you can ask the onsite doctors at a Luxottica Retail location if they can donate a free eye exam.
- Take your referral letter and prescription from an eye doctor to a participating Luxottica Retail location — which includes LensCrafters, Target Optical and Pearle Vision corporate stores — to get your free pair of eyeglasses.
Check out OneSight’s website to learn more about its vision voucher program.
Cheap Online Eyeglass Retailers
Buying eyeglasses online is a cheap alternative to paying hundreds of dollars for a fancy pair at your optometrist’s office.
According to a recent survey from Consumer Reports, people who bought glasses online paid a median of $91, while those who shopped in-store spent $234.
Some online retailers, like Zenni Optical, offer single prescription glasses starting at just $7. You’ll pay more for special coatings, progressive lenses and other add-ons.
Many of these sites offer virtual “try on” features and come with convenient return policies so you can find frames and lenses that work for you.
Does It Make Sense to Buy Private Vision Insurance on Medicare?
Medicare beneficiaries can purchase private vision insurance to help offset the cost of eyeglasses and routine eye exams. According to KFF, medicare patients spent an average of $230 out of pocket on vision care in 2018.
Plans are generally inexpensive — usually $10 to $15 a month — and premiums usually don’t increase with age like other types of health insurance.
However, private insurance monthly premiums, copayments and deductibles may not make it worthwhile.
You should carefully examine any private vision insurance plan benefits and costs before signing up. Make sure the plan actually saves you money on eyeglasses and routine exams.
Does the VA or Medicaid Cover Eyeglasses and Eye Exams?
Medicare may not be your only form of insurance.
If you are also enrolled in Medicaid or Veterans Affairs health benefits, you may qualify for free or low-cost vision care.
Medicaid Vision Coverage
Medicaid will cover eye exams for adults ages 21 and older in most states — but not all.
Medicaid is a federally funded health insurance program for people with low incomes. It’s administered at the state-level, so each state determines its own vision benefits and limitations.
According to KFF:
- At least 42 states offer some coverage for optometrist services.
- At least 33 states offer some coverage for eyeglasses.
In states that do provide vision benefits, basic eye exams are covered. Prescription glasses with basic frames are also usually covered, but each state has specific caps.
Copays for eye exams with Medicaid are affordable, usually $15 or less.
Research your specific state’s Medicaid vision coverage or contact your local Medicaid office for more information. Speaking with a local Medicaid office and your individual plan provider is the best way to understand your specific vision benefits.
Once you’re clear on your coverage, make sure your eye doctor accepts Medicaid before scheduling an eye exam.
VA Vision Coverage
If you have VA health care benefits, the program will cover your routine eye exams and preventive vision testing.
Talk to your VA primary care provider or contact your nearest VA medical center or clinic for more information.
Veterans can also qualify for free eyeglasses or contact lenses by meeting one of the following criteria:
- Have a disability linked to your military service for which you’re receiving VA disability payments.
- Are a former prisoner of war,
- Were awarded a Purple Heart.
- Receive benefits under Title 38 United States Code (U.S.C.) 1151.
- Receive an increased pension because you’re permanently housebound and in need of regular aid.
- Experience vision problems caused by another illness — such as stroke or diabetes — for which you’re receiving VA care.
- Suffer from geriatric chronic illnesses (long-lasting illnesses that affect the elderly).
The following groups can also qualify for free eyeglasses through the VA:
- Veterans with significant functional or cognitive impairments.
- Veterans with a vision impairment severe enough that it interferes with their ability to participate in their own medical treatment.
- Veterans who have service-connected vision disabilities rated 0%.
Rachel Christian is a Certified Educator in Personal Finance and a senior writer for The Penny Hoarder.
This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.