For people ages 65+, there are a number of ways to get vision insurance. For some, vision coverage options may come through the Medicare Advantage program, these plans are offered through private insurance companies approved by Medicare. You could also purchase a stand-alone vision plan through a private insurer. In this article, we cover the basics of what the government run healthcare options offer to recipients and some of the choices available to them today.

Affordable Care Act and vision insurance

Under the Affordable Care Act (ACA), vision coverage is not mandated. If you are still employed and looking ahead to vison insurance plans, it may be a good idea to look into vision plan options while you have the coverage, to determine your future needs. Supplemental vision insurance plans can be purchased on their own or with an individual or family health insurance plan. These vision plans may not be necessary if you don’t have vision issues, but if you require eye exams or other routine vision care, this could be a good option for you until you sign up for Medicare.

Vision Insurance for Medicare Beneficiaries

Whether you’re 65+ and enrolling in Medicare, or in your early sixties and planning ahead, now is a great time to be aware of your vision insurance options.

According to the Center for Disease Control, adults 40+ are the most at risk for a variety of eye disease. Because of this, individuals 64+ are recommended to get annual eye exams, and bi-annual exams if they have existing eye conditions.

For those still working, vision insurance can be included in or added to the health insurance provided by their employers. But if you are planning for retirement, it is a good idea to know what your health insurance options are, as well as your current and future eye care needs. Here is a brief list of some  eye care needs that are good to keep in mind when looking into coverage:

• Eye Examinations
• Eyeglass Frames
• Contact Lenses
• LASIK

Original Medicare does not cover routine eye care

Unfortunately, Original Medicare doesn’t cover eye exams and eyewear (glasses and contact lenses), you’ll have to pay for these costs out of pocket. There are, however, a number of exceptions under Medicare Part B.

Under Medicare Part B, beneficiaries diagnosed with diabetes are covered for annual eye exams to check for diabetic retinopathy. In addition to this, Medicare Part B covers annual glaucoma tests if you are at high risk, with any of the following factors:

• Diabetic
• African American 50+
• Hispanic 65+

Part B covers exams for these reasons but not routine exams for the purpose of getting contact/glasses prescriptions.

In some cases, Medicare covers vision-related issues in the event of illness or an injury that results in eye damage. Medicare pays 80% of approved amounts for vision-related issues and services covered by Medicare Part B, and the beneficiary pays 20%.

For items such as glasses, contact lenses, artificial lenses, and artificial eyes, you must use a Medicare-approved supplier to get Medicare coverage. Lastly, Medicare Part B can cover some diagnostic tests and treatments if you have macular degeneration (AMD).

Medicare Advantage may offer routine vision coverage

While a Medicare Advantage plan can offer supplemental vision benefits.  Original Medicare (Part A and Part B) typical does not cover routine eye exams, contact lenses or eyeglasses.

If you are eligible for Original Medicare, you can then choose to enroll into a Medicare Advantage plan from an approved private insurance company that contract with Medicare. The eligibility for Original Medicare is as follows:

• 65 years +
• Receiving Social Security Disability Insurance (SSDI)
• Have end-stage renal disease (ESRD)
• In hospice care

If you do qualify, you can find a Medicare Advantage plan that will cover your vision needs. To find the Medicare Advantage supplier in your state, you can use the online Medicare finder tool. If you have any further Medicare related questions, contact Medicare representatives at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week; TTY users call 1-877-486-2048.

eHealth can help you get covered

Whatever your vision needs and concerns may be, eHealth can help! Visit our Vision Insurance assistance page to find and compare the different plans available to you and your loved ones today. As always, contact eHealth’s licensed insurance agent if you need any additional help <1-877-456-6670> (TTY 711) <Mon–Fri, 6am–4pm PT>