Marci’s Medicare Answers: Are eyeglasses covered?
I need to get eyeglasses to correct my vision. Does Original Medicare cover eyeglasses?
Original Medicare, the traditional fee-for-service Medicare program offered directly through the federal government, only covers eyeglasses after you have had cataract surgery. Original Medicare generally does not cover routine eye care, such as examinations for prescribing or fitting eyeglasses.
However, Original Medicare will cover a standard pair of untinted prescription glasses or contacts, if you need them after cataract surgery. If considered medically necessary, Medicare may cover customized eyeglasses or contact lenses following the procedure.
Keep in mind that Medicare may not pay for the entire cost of your eyeglasses. Although it may pay for a portion of the cost of your eyeglasses, you may have to pay a deductible or coinsurance.
Remember, a deductible is the amount you must pay out of your own pocket for a health care service or item, before your health insurance begins to pay. A coinsurance is the percentage you must pay for a health care service or item you receive.
While Original Medicare generally does not cover routine eye care, Medicare Advantage plans, also known as Medicare private health plans, may offer limited coverage of vision services.
If you have a Medicare Advantage plan, contact your plan directly, to find out if your plan will cover your eyeglasses.
I received an Explanation of Benefits from my Medicare Advantage plan. What is an Explanation of Benefits?
An Explanation of Benefits is the notice you receive from your Medicare Advantage plan, after you have received health care services from a doctor or other health care provider. It tells you what your doctor or health care provider billed the plan for the services you received.
The Explanation of Benefits also lists what the plan paid to your provider for the services you received, as well as the amount you owe to your provider.
Keep in mind that it is not a bill; rather, it is a summary of the services you received and how much you may owe for them. Your provider will send you a bill for any fees you owe.
If you already paid your provider for the health care services you received, make sure you check your summary to confirm that you paid the right amount. If you have questions about the amount you owe, you can call your plan or health care provider.
If you have Original Medicare, you will receive a Medicare Summary Notice, as opposed to an EOB. The Medicare Summary Notice is similar except that it is typically sent every three months to those with Original Medicare. It also is not a bill and simply lists the services you received and the amount you must pay for those services.
If Original Medicare or your Medicare Advantage plan is not paying for a service you think should be covered, you should appeal. There are usually instructions on how to appeal. If you have Original Medicare and you need help understanding your MSN, call 800-MEDICARE. If you have a Medicare Advantage plan and you need help understanding your EOB, you can contact your plan. You may also contact your State Health Insurance Assistance Program for help with the appeals process.
I need to see a dentist for a routine checkup. Does Medicare cover routine dental care?
No, Medicare typically does not cover routine dental care. Medicare may cover some dental services if they are required to protect your general health.
For example, Medicare may cover dental care if you need it for a Medicare-covered health service to be successful. However, Medicare will not cover dental care that you need primarily for the health of your teeth (i.e. routine dental care).
Under Medicare law, Original Medicare strictly does not cover routine dental services. While some Medicare Advantage plans may cover dental services, this coverage may be limited and can change from year to year. If you have a Medicare Advantage plan, contact your plan to learn more about their rules on dental coverage.
Although Medicare does not cover dental care, Medicaid may cover your dental services. Remember, Medicare is the health insurance program for people 65 or older and people with disabilities, whereas Medicaid is the health insurance program for individuals with low income.
Medicaid programs vary by state, so check with your state Medicaid program to learn more about how Medicaid covers dental care.