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Medicaid, Medicare, and Vision Care

Many people have questions about Medicaid and Medicare, and what each program offers for eye care.

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Do You Need Vision Insurance?

It is important to have good medical insurance to maintain your health. The decision to purchase vision insurance can be complicated since many aspects of eye care are not covered by regular medical insurance.

Generally speaking, eye care that is related to an overall medical condition falls under your healthcare policy. An example of this would be where a doctor deems an ocular exam necessary for a diabetic with high blood. In such circumstances, medical insurance may cover the cost of an appointment with an optometrist under the framework of general health.

Some medical insurance plans offer supplemental plans to cover eye care. Others combine vision and dental care coverage as a package. Depending on your individual needs, you will need to determine if it is a worthy investment. For those who require extensive vision care, the costs can add up. Vision insurance may be the way to go.

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The Beginner's Guide To Vision Insurance

There are many different kinds of vision insurance on the market, and they all have their own benefits. Plans may offer the following benefits:
  • Coverage for contact lenses or prescription glasses, either free of cost or at a reduced price.
  • Coverage for annual exams
  • Copayments and deductibles saving you money for the overall cost
  • Top tier plans often feature partial coverage for surgical ocular procedures

How Much Does Vision Insurance Cost?

Prices vary depending on how extensive the plan. Simple plans can be as low as $10 monthly. Higher tier plans can cost as much as $30 monthly but may offer top-tier benefits such as discounts on corrective surgery such as LASIK.

Things To Consider

When shopping around for a vision insurance plan consider the following:
  • your personal medical profile and individual needs
  • monthly cost
  • cost of copayments or deductibles
  • company rating
  • types of benefits, including the cost of prescription lenses and frequency of benefits
  • Identifying visual-motor and neurological deficits and implementing corrective measures including a rehabilitation plan of Vision Therapy
Are Medicaid and Medicare Viable Options For Vision Care?

Are Medicaid and Medicare Viable Options For Vision Care?

Medicaid and Medicare are federal and state programs providing assistance and insurance for seniors and people with a low income. While neither program offers extensive vision care, speak with state providers to see if you are eligible and to determine if they provide viable options for you.

Medicaid

Medicaid is run jointly as a federal-state program providing medical assistance to anyone with a low income regardless of age. The benefits vary by state, and it is either free or available with partial payments. Benefits include the following:
  • As part of The Early, Periodic, Screening, and Diagnostic Program (EPSDP), states provide glasses and eye exams for children and young adults. The amount of coverage depends on what is deemed medically necessary. Benefits vary by state.
  • Does not cover surgeries for refractive error

Medicare

Medicare is a federal program providing medical insurance for all seniors regardless of income, including younger disabled people. The cost is low, either in the form of low monthly premiums for non-hospital care and deductibles. Medicare does NOT provide coverage for routine eye exams, and in most cases, it will not cover contact lenses or glasses. However, it does offer the following benefits:
  • An annual exam for diabetics and those at high risk for glaucoma
  • Coverage for certain procedures, tests, and surgeries for ocular diseases and conditions
  • Eye exams to check for serious conditions
  • Medicare Part B offers coverage for glasses following cataract surgery if you had an intraocular lens attached post-surgery
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Do You Need Vision Insurance?

Do You Need Vision Insurance?

  • Do you have poor vision and require frequent examinations that aren't covered by medical insurance?
  • Will you be purchasing prescription glasses or contact lenses during the year?
  • Are you considering corrective surgery?

Generally speaking, Medicaid and Medicare provide limited benefits for vision. For those with a limited income, contact a state Medicaid or Medicare provider to find out if they offer viable options that match your needs.

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Common Questions

Vision insurance typically is used for eye exams, frames, lenses and contacts whereas medical insurance is generally used only for exams that have a medical nature such as dry eye or another medical diagnosis.
Eye conditions such as amblyopia, strabismus, convergence insufficiency and binocular vision dysfunction are treated in vision therapy. These conditions are classified as medical issues rather than refractive errors, and therefore would normally fall under medical insurance as opposed to vision insurance. However, as each diagnosis and medical insurance have their own regulations about what is covered in each circumstance, it is impossible to give a standard answer to what is covered by every plan. Therefore, depending on the type of eye condition and plan, Medicaid may cover vision therapy.
Medicaid, Medicare, and Vision Care
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Everyone's medical requirements are different. Vision insurance isn't right for everyone. However, for those who require more extensive vision care, a good insurance plan can save them a lot of money.

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