Countless seniors rely on Medicare for their health-related needs in retirement. Unfortunately, the scope of Medicare's coverage is somewhat limited -- a shortcoming that tends to catch countless retirees off guard. In fact, one major service that Medicare typically doesn't cover is routine vision care. Though Medicare will pay for certain eye care services, like cataract surgery, it won't cover the cost of eyeglasses or contact lenses. You'll therefore need to prepare to absorb certain vision-related expenses yourself if you're planning to stick with traditional Medicare -- either that or get yourself a Medicare Advantage plan.
Medicare: Stingy on routine eye care
As we age, we're more likely to experience a host of vision-related issues. And, unfortunately, in many cases, Medicare won't cover those issues. For example, if you're having trouble seeing out of your current pair of glasses, Medicare won't pay for you to have your eyes checked, nor will it pay for a replacement pair.
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But while Medicare doesn't cover what's considered routine eye care, it will cover certain eye issues that are deemed medical problems. For example, Medicare Part A, which covers hospital stays, will pay for vision care related to medical emergencies or traumatic injuries. Medicare Part B, meanwhile, will typically cover cataract surgery. (Since it's an outpatient procedure, it falls under Part B, not Part A.) Specifically, Medicare will cover the removal of the cataract, basic lens implants, and one set of prescription eyeglasses or one set of contact lenses following the surgery.
Medicare Part B will also cover an annual eye exam for diabetic retinopathy provided you've officially been diagnosed with diabetes. Furthermore, Part B will cover a glaucoma test once a year for those at high risk for the disease. Additionally, Part B will cover certain diagnostic tests or treatments related to eye disease, including injections for age-related macular degeneration. Keep in mind that in all of these cases, you'll still generally be responsible for 20% of the Medicare-approved amount of each treatment or procedure, but the bulk of the cost will be absorbed by Medicare.
Making up for missing coverage
If you're worried about keeping up with the cost of vision care in retirement, you may be considering a Medigap plan. Also known as Medicare Supplement Insurance, Medigap, as the name implies, is designed to help bridge the coverage gap so many Medicare enrollees face. The problem, however, is that Medigap doesn't typically cover vision care, so paying for it won't do you much good if your primary goal is to get your eye exams and glasses for free.
On the other hand, one plan you can consider is a Medicare Advantage plan. Also known as Medicare Part C, Medicare Advantage is designed to offer the same level of coverage as traditional Medicare at a minimum. In reality, most Advantage plans' benefits surpass those of original Medicare, and many cover vision services to boot. Furthermore, Medicare Advantage can actually end up being cheaper than traditional Medicare, though not always. To see if an Advantage plan makes sense for you, you'll need to do a cost comparison and figure out where you're more likely to come out ahead financially.
Now that you're aware that Medicare won't cover routine vision care, you can take steps to plan for this added expense. This might mean saving more money during your working years or cutting some of your senior living costs to free up more room in your budget for your health-related needs, vision care included. At the end of the day, Medicare clearly isn't perfect, but the sooner you get educated on what it will and will not pay for, the better equipped you'll be to make up for those limitations one way or another.
