Experiencing vision problems as you age is something seniors know all too well.
Even if you’ve never experienced vision issues previously, you’re more at risk for developing conditions such as macular degeneration, glaucoma and cataracts as you get older.
Regular eye exams and taking care of any vision issues that come up are important so that you can maintain an active lifestyle well into your senior years.
However, the cost of purchasing eyeglasses and contact lenses, and seeking treatment for more serious conditions, can get expensive.
For most seniors, Medicare provides coverage for their medical needs. But, depending on which plan you have, costs associated with vision care may or may not be covered.
Below we’ll explore what policies provide coverage, and what other resources are available to help you get the right vision insurance policy that meets your needs and budget.
What Medicare Covers
Medicare is available to most seniors age 65 and older, but also to those younger than 65 with certain disabilities. Medicare includes four parts: A, B, C and D.
When signing up for Medicare, you generally select one of two choices. You either enroll in Original Medicare (Parts A and B), or you enroll in a Medicare Advantage Plan (Part C). (Part D is a prescription drug plan and only available to seniors who sign up for Parts A and B.)
Original Medicare covers hospital and medical expenses, while a Medicare Advantage Plan requires enrollees to sign up with an insurance carrier, which then provides primary coverage for Medicare-related costs. Both have similarities, but one of the areas where they differ is in vision coverage.
In general, vision insurance does not come standard with Original Medicare. However, this plan will cover diseases and disorders of the eyes, and Medicare B will cover the following preventive and diagnostic exams:
- Eye exams, if you have been diagnosed with diabetes
- Glaucoma tests
- Macular degeneration tests and treatment for those at high risk
Original Medicare also will cover vision care if it is the result of a condition that is considered a serious medical problem. For example, Original Medicare typically will cover any injuries or care needed from a traumatic eye injury. Part B also will cover cataract surgery.
If you’re simply in need of eyeglasses or contact lenses, you’re out of luck with Original Medicare. However, Part B will help pay for corrective lenses (a pair of eyeglasses or a set of contact lenses) if you have had cataract surgery in which doctors have implanted an intraocular lens.
Medicare Advantage Plan
Because you sign with an insurance carrier to provide your Medicare benefits, Medicare Advantage Plans allow you to bundle a purchased vision plan with your regular healthcare plan.
Some Medicare Advantage plans even will provide full coverage, such as for routine vision exams or vision correction products.
Each Medicare Advantage plan differs, and factors such as location play a role into what coverage is available. That’s why it’s important to check with a licensed insurance agent who can help you navigate which Advantage plans are available to you.
Your Other Choices
Medigap policies, or supplemental insurance plans, are popular choices among Original Medicare recipients to help pay for healthcare costs that are not covered by their plans, including co-payments, coinsurance and deductibles. It’s important to note that Medigap policies do not include vision coverage.
If you are enrolled in Original Medicare, however, private insurance carriers do offer separate plans to help meet your vision care needs. Often, in fact, vision insurance carriers have plans available tailor-made for Medicare participants.
These stand-alone policies differ among carriers, but usually cover basic levels of care that include eye exams. Seniors typically will pay a premium each month for coverage, and may pay a copay for exams and other services. There often is a fixed dollar amount of coverage that can be used to cover the costs of glasses, contacts or other care.
You may find that discount plans are a better option for your budget and coverage needs. These types of plans don’t provide the same comprehensive coverage you will get with an insurance policy.
With discount plans, you instead pay into a program and then get a discount applied to any care you receive. This is usually a flat percentage, such as 25% off a service included in the plan, regardless of the cost.
How An Agent Can Help
Sorting through your vision insurance options can be overwhelming, especially if you’re navigating all the choices available to you for your other healthcare needs at the same time.
However, vision care is an important component of your health you don’t want to overlook or put aside while you worry about how your other healthcare needs will be addressed. Diseases such as macular degeneration and diabetic retinopathy, if untreated, can lead to permanent vision loss in various degrees. Getting routine care is an important step to ensuring your eyesight stays intact as you age.
It’s important to look for a licensed vision insurance agent who has experience navigating plans that either complement your Original Medicare policy or are bundled with your Medicare Advantage policy. This will help ensure you make the most informative decision.
In California, there is no cost to you to enlist the help of an agent. Other benefits they will provide include:
- Get quotes and a variety of policy options based on your specific needs
- Work with several insurance companies, and provide you with options
- Assist when it comes time to renew your policy
- Advocate for you regarding any claims or issues with your policy
Working with a licensed agent can alleviate some of the stress associated with policy shopping, and help make the process go more smoothly and quickly.