How Vision Coverage Works

Let's look at ways to keep your eyesight as sharp as possible.

Take good care of your eyes so they can take good care of you. That advice is much easier to follow with a vision plan that helps cover some health care costs. Vision plans focus on preventive care, including annual exams and screening for conditions that could get worse over time — services that Original Medicare doesn’t cover.

Most vision plans can also make eyeglasses and contact lenses (also not typically paid for by Medicare) more affordable. They may even help pay for certain surgical procedures like PRK (photorefractive keratectomy), LASIK and cataract surgery. So, it’s a good idea to consider vision coverage as part of your overall approach to health care.

What Medicare covers

Original Medicare by itself only covers certain vision-related costs, which may include:

Annual diagnostic tests for glaucoma if you’re at high risk of developing it, diabetic retinopathy if you’ve been diagnosed with diabetes, and treatments for macular degeneration.
Certain kinds of cataract surgery and one set of glasses or contact lenses, if required, following the procedure.
Hospitalization if you’re an inpatient receiving surgery or treatment specifically for an eye-related injury or condition.
Eyelid lift surgery, if you can establish that it’s medically necessary.

Vision plans

Vision coverage is available as part of many Medicare Advantage (Part C) plans, or as a separate “stand-alone” policy. Medicare Supplement plans do not offer vision coverage as a benefit, though you can purchase it separately.

Like other kinds of ancillary insurance, stand-alone vision plans are a hybrid. They combine traditional medical insurance, which pays some or all the charges from your eye doctor’s office, and discount programs, which offer reduced prices on eyeglass lenses, frames, contacts, and related products.

Monthly premiums for vision coverage average between $5 and $15 . Cost-sharing provisions (deductible, copay or coinsurance) vary. Many plans offer two or three tiers of coverage (basic, intermediate and comprehensive), which is reflected in the premium, cost-sharing and other terms. More comprehensive coverage typically costs more overall than basic coverage.

What to look for in a vision plan

Network: Most plans have a preferred provider network. To receive benefits and get the lowest prices, you’ll need to choose in-network doctors and sources for lenses and frames.
Eye exam and screenings: All basic-level vision plans cover these at no extra charge. Some plans may provide partial coverage for the special exam needed for contact lenses.
Correction: Many plans offer a discount, which may vary, for contact lenses and eyeglasses if you purchase them from in-network sources.
Specialty lens options: Some plans help you pay for special coatings and features that may be available with your glasses.
Benefit cap: Many plans limit the maximum discount or benefit you can receive during the plan year. It resets when a new plan year begins.
Guaranteed acceptance: Your application for vision coverage can’t be turned down, regardless of your medical history.
Waiting period: Some vision plans require a waiting period, typically 30 days or more, before you can use the plan’s benefits.
Automatic renewal: Whether your vision coverage comes through a Medicare Advantage or a stand-alone plan, you’ll automatically be re-enrolled at the end of each plan year unless you choose otherwise, or if the plan becomes no longer available in your area.

Is a vision plan right for you?

What to do next depends on which Medicare health plan you have or are considering.

If you’re...	...then consider
about to enroll in Original Medicare for the first time	choosing a Medicare Advantage plan that includes vision coverage or adding a stand-alone vision plan.
already enrolled in Original Medicare only	switching to a Medicare Advantage plan that includes vision coverage, or adding a stand-alone vision plan.
already enrolled in a Medicare Advantage plan that includes vision coverage	switching to a different Medicare Advantage plan with better vision coverage or more benefits.
enrolled in a Medicare Advantage plan with no vision coverage	switching to another Medicare Advantage plan that offers vision coverage, or enrolling in a stand-alone vision plan.
enrolled in a Medicare Supplement plan	adding a stand-alone vision plan. Note: You may not be able to re-enroll in Medicare Supplement if you switch to a Medicare Advantage and/or the costs may be higher if you switch back.

Bottom line: Is your eyesight worth it?

Vision coverage gives you a lot to think about, but protecting your eyesight can be worth it. Plans are relatively inexpensive and can provide significant cost savings on eye care. How much you save depends on how much care and correction you need, as well as the doctors and services you use. For most people on Medicare, especially those on Medicare Advantage plans, the plans make economic sense, are important to your health and deserve consideration.

An Alight licensed Benefits Advisor can help guide you through your options. Call 844-360-4712 to schedule an appointment.

Caring for Your Vision