Do seniors need private vision insurance to supplement the limited Medicare coverage? Probably not. You’re wise, though, to look at your options, especially if you’re retired and no longer enrolled on a vision insurance plan through your employer.
Medicare does not cover routine eye care, explains Diane J. Omdahl, RN, MS, president of 65 Incorporated. That lack of coverage means you’re likely to pay out of pocket for eyeglasses and contact lenses, and the routine eye exams needed to get your prescription.
“While AARP has supported expanding Medicare coverage to include vision care for some time, I don’t think AARP has advocated that all Medicare beneficiaries should buy private vision insurance,” said Keith Lind, senior strategic policy adviser for the AARP Public Policy Institute.
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Pros and cons of vision insurance for seniors
With private vision insurance, it’s possible to save money on glasses and frames, Omdahl said. But choices are more limited, and you’ll have to pay out of pocket for upgrades.
Network limitations are a big disadvantage. If your eye doctor isn’t in the network, you’ll have to find a doctor who is in-network. That means getting that doctor up to speed on a lifetime of eye issues you may have experienced.
For example, “Jennifer’s” eye doctor, who had treated her for years, told her that when she was ready to have a complicated eye surgery to treat an alarming number of floaters in her eyes, he’d perform the surgery.
They had built up decades of trust. When Jennifer moved out of state and saw a new eye doctor for the first time, the new doctor felt like Jennifer was too pushy and demanding.
“So many seniors have established relationships with ophthalmologists and don’t want to jeopardize their eyes by changing to possibly save money,” Omdahl said.
Is vision insurance for seniors worth the cost?
Despite Medicare’s limited vision coverage, you’re probably better off without buying a private vision plan. Coverage offered under private vision insurance also can be limited, Lind said. You will still have to pay some out-of-pocket costs.
For example, premiums for a private vision insurance plan offered in Washington, D.C., range from $300 to $400 per year plus a minimum of $40 for the eye exam and basic lenses. That cost sharing can run $200 to $300 depending on what lens and custom frames you choose, Lind said.
Save money by self-insuring
Based on this example, you could save money by self-insuring, Lind said. Simply deposit an amount equal to the annual premium in a savings account and pay out-of-pocket for the exam and eyeglasses, he added.
What vision services does Medicare cover?
Medicare Part A, hospital insurance, will cover treatment of eye conditions, such as a traumatic eye injury, when hospitalization is required, Omdahl said.
Medicare Part B, medical insurance, covers 80 percent of the cost of outpatient surgery for certain eye conditions such as a detached retina and cataracts, Lind said. Beneficiaries are responsible for the remaining 20 percent and the Part B deductible, he said.
Part B also covers screenings that are medically necessary to diagnose and treat eye conditions, Omdahl said.
Examples or Part B coverage include:
- Cataract removal with limited coverage of eyeglasses or contact lenses after surgery
- Screenings for glaucoma and diabetic retinopathy
- Diagnosis and treatment of macular degeneration
- Retinal detachment
- Eye cancer
- A scratched eye
- Eye prostheses for those with absence or shrinkage of the eye due to birth defect, trauma or surgical removal
Medicare Advantage plans cover some vision benefits
Medicare Advantage, sometimes called Plan C, is an alternative way to get Medicare coverage through private vision insurance, said Jane Sung, senior strategic policy adviser at the AARP Public Policy Institute.
Medicare Advantage plans offer additional benefits that traditional Medicare does not cover, Sung said. Limited vision coverage is one of the most commonly offered benefits, she said.
More than eight out of 10 Medicare Advantage plans offer some type of vision benefits, according to an AARP white paper. These benefits can include a basic eye exam, contact lenses, eyeglass lenses and eyeglass frames.
Medigap plans offer vision benefits
Medicare Supplement plans, often called Medigap plans, also provide vision coverage or discounts. These vision plans are standardized by federal and state law, Sung said.
Although vision coverage is not provided by standard Medigap plans, some insurers partner with an optometry group and offer discounts for vision services, Sung said.
And in some states, Medigap insurers are allowed to add certain “new and innovative” benefits approved by the state, which can include vision benefits, she said.
Read the fine print on your vision plan
Do your due diligence on any private or supplemental vision insurance plan.
“Each insurance plan is different,” said Margaret Mondul, founder of Household Document Organization. “These are all PPOs or HMOs so you only get these benefits if you use their providers, which are often few and far between. Read the fine print.”
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