Does Medicare cover Vision?
Vision coverage under Medicare is something that most folks will ask us about when we meet with them to go over their options. Unlike employer group coverage, basic vision isn’t covered by Medicare, so it leaves a lot of people unsure of what to do regarding coverage. Things related to eye disease like cataracts and glaucoma are covered by the Medicare, but not anything elective (ie: eye exam) or cosmetic (ie: Lasik). We’re going to highlight some of the various recommendations we make to cover your vision in retirement.
COBRA
If you’re nearing retirement, leaving employer coverage and going onto Medicare for the first time then our recommendation for vision coverage, like dental, is to elect COBRA. COBRA is just an extension of your employer plan that you can keep for up to 18 months. However, instead of your employer paying all or some of the premium you pay the full premium price.
A lot of people are unaware that you can continue the vision and dental coverage without the Medical portion of the group plan. Employers with 20 or more employees are required to offer continuation of coverage through COBRA in instances where coverage would otherwise end, in this case, retirement. You have 60 days after your retirement date to elect into COBRA, after that time frame you become ineligible. You should receive information for COBRA via mail, shortly after your retirement date, or you can inquire with your HR department.
Your Medicare Plan Might Have Some Vision Coverage
Medicare Supplemental plans, in most cases, will not include any extra coverage for vision. In the few instances where a Supplemental or Medigap plan does offer some vision benefit, it’s usually not tied into the insurance portion of the plan and is instead considered an “ancillary” benefit. For example: instead of having a copay amount of $25 for every visit to the eye doctor, a plan might instead provide a $100 allowance to use towards glasses or contacts.
Some Medicare Advantage plans will include coverage for an annual eye exam as well. They may also include a vision hardware reimbursement up to a certain dollar amount every year. With these types of plans you’ll want to be aware of any network restrictions that may apply. You wouldn’t want to visit an eye doctor thinking it’s covered and then be told that the doctor doesn’t accept your plan, leaving you with the entire bill.
Pay out of Pocket vs. Standalone Vision Plans
For folks whose COBRA coverage is ending or who don’t have added coverage for vision in their Medicare Supplement or Advantage plan, there aren’t many options besides enrolling into a standalone vision plan with a private insurance company, or just paying out of pocket. Our general guidance in these situations is to just pay out of pocket. If you’re only going for an annual exam and getting new glasses every 2–4 years, a standalone plan just doesn’t make much financial sense. You end up paying a monthly premium (usually around $15-$20) and still have out of pocket expenses for services and hardware.
If you were to just pay out of pocket for your annual exam which usually runs about $100, you still have an annual net saving vs. paying a monthly premium price. For hardware items, there are numerous online retailers that offer prescription eyewear at a fraction of the cost of what you would pay at a physical location. These reasons are why we typically recommend just paying out of pocket for your vision coverage. On top of that, most standalone vision plans won’t provide any coverage for major services like surgery.
If you have some major issues relating to your eyes or vision, then picking up a standalone plan might be beneficial for you. In these cases, it would be helpful to do a cost-benefit analysis to see what you would pay with insurance vs. without. Remember, Medicare will cover eye disease like glaucoma and cataracts, so factor those coverages in to your final analysis.
Ultimately you have to make the decision on whether or not to buy vision coverage in retirement. While it will help cover some of the out of pocket costs it still may not make financial sense in the long run.
About Doctor’s Choice:
Doctor’s Choice is the premier service advocate for Medicare, making healthcare transitions easy for employers and their employees. Founded by a Brown University-trained Physician, they deliver best-in-class service to seniors before, during and after their transition to Medicare. Offering coverage across the country and tech-enabled personalized guidance through their Turbo Medicare Roadmap, Doctor’s Choice provides concierge-level service and healthcare advocacy to our members for life. For more insights on retirement trends and employer strategies for an aging workforce, follow Doctor’s Choice on LinkedIn @DoctorsChoice, Twitter @DoctorsChoiceU, and Facebook @DoctorsChoiceUSA.