Do seniors require private vision insurance to supplement their Medicare coverage, which is limited? Most likely not. It's a good idea to look into your options, especially if you're retired and no longer have access to a vision insurance plan through your employer.
As Diane J. Omdahl, RN, MS, president of 65 Incorporated explains in this video, Medicare does not cover routine eye care. Because of this deficiency in coverage, you will almost certainly have to pay out of pocket for eyeglasses and contact lenses, as well as for the routine eye exams required to obtain your prescription.
The American Association of Retired Persons (AARP) has supported expanding Medicare coverage to include vision care for some time. However, Keith Lind, senior strategic policy adviser for the AARP Public Policy Institute, believes that AARP has never advocated that all Medicare beneficiaries purchase private vision insurance.
The advantages and disadvantages of vision insurance for seniors
According to Omdahl, it is possible to save money on glasses and frames by purchasing private vision insurance. However, the selection is more limited, and you'll have to pay for any upgrades out of pocket.
The inability to connect to the internet is a significant disadvantage. It is your responsibility to find an eye doctor who is part of the network if your current eye doctor does not participate. That means bringing your doctor up to speed on any eye issues you've had over the course of your life.
Jennifer's" eye doctor, who had treated her for years, told her that when she was ready to have complicated eye surgery to treat an alarming number of floaters in her eyes, he would be the one to perform the surgery.
They had built up a long-term relationship of trust. Jennifer had recently relocated out of state and was visiting a new eye doctor for the first time. The new doctor thought Jennifer was being too pushy and demanding.
So many seniors have developed relationships with ophthalmologists and do not want to risk their vision by switching practices in order to save money, according to Dr. Omdahl's findings.
Is it worthwhile to invest in vision insurance for seniors?
Despite the fact that Medicare only provides limited vision coverage, you're probably better off not purchasing a private vision plan. According to Lind, the scope of coverage provided by private vision insurance can also be limited. You will still be responsible for some out-of-pocket expenses.
The cost of a private vision insurance plan in Washington, DC, for example, ranges from $300 to $400 per year, plus a minimum of $40 for an eye exam and basic lenses. Lind estimates that the cost sharing will range between $200 and $300, depending on the lenses and custom frames you choose.
Self-insuring allows you to save money.
According to Lind, self-insuring could result in significant savings in the long run. Simply put aside an amount equal to the annual premium in a savings account and pay for the exam and eyeglasses out of pocket, he explained.
What types of vision services are covered by Medicare?
Omdahl explained that when hospitalization is required for eye conditions such as a traumatic eye injury, Medicare Part A, hospital insurance, will cover the cost of the treatment.
Lind explained that Medicare Part B, which is medical insurance, covers 80 percent of the cost of outpatient surgery for certain eye conditions such as a detached retina and cataracts. In addition to the Part B deductible, he explained that the remaining 20% is the responsibility of the beneficiaries.
The screenings covered by Part B include those that are medically necessary for diagnosing and treating eye conditions, according to Omdahl.
The following are examples of Part B coverage:
Removal of a cataract with only limited coverage of eyeglasses or contact lenses following surgery
Examinations for glaucoma and diabetic retinopathy are performed.
Macular degeneration is a condition that can be diagnosed and treated.
Detachment of the retina
Cancer of the eye
An eye that has been scratched
People who have lost or shrunk their vision due to a birth defect, trauma, or surgical removal can benefit from eye prostheses.
Some vision benefits are covered by Medicare Advantage plans.
As explained by Jane Sung, senior strategic policy adviser at the AARP Public Policy Institute, Medicare Advantage (also known as Plan C) is an alternative way to obtain Medicare benefits via private vision insurance, which can be obtained through an employer.
Sung explained that Medicare Advantage plans provide additional benefits that are not provided by traditional Medicare. A limited vision coverage plan is one of the most frequently offered benefits, according to her.
According to an AARP white paper, more than eight out of every ten Medicare Advantage plans provide some form of vision coverage to their members. In addition to a basic eye exam, these benefits may include contact lenses, eyeglass lenses, and eyeglass frames.
Vision coverage is included in some Medigap policies.
Medicare Supplement plans, also known as Medigap plans, may include vision coverage or discounts in addition to other benefits. According to Sung, these vision plans are standardized by federal and state legislation.
However, even though standard Medigap plans do not provide vision coverage, some insurers have partnered with a local optometry group to provide discounts on vision services, according to Sung.
Additionally, in some states, Medigap insurers are permitted to offer certain "new and innovative" benefits that have been approved by the state, which can include vision coverage, according to her.
Pay attention to the small print in your vision plan.
Make sure you do your research before enrolling in any private or supplemental vision insurance plan.
In the words of Margaret Mondul, the founder of Household Document Organization, "every single insurance plan is unique." In the case of all PPOs and HMOs, you will only be able to take advantage of these benefits if you use their providers, which are frequently few and far between. "Be sure to read the fine print."
