Ask The Optician...about Medicare, Insurance and your eyeglasses

Ask the Optician

Medicare, Insurance and my Eyeglasses

Your optical questions answered by Joel C. Wolf licensed Optician and owner of Village Opticians

Does my Medicare coverage pay for my eyeglasses?

Medicare will pay for your first pair of glasses after cataract surgery with an implant (frame and a pair of lenses). If you have cataract surgery on your second eye you are entitled to a second pair of eyeglasses if first pair of glasses are received before second cataract surgery.

Medicare will pay for one pair of eyeglasses each year if you have had cataract surgery without an implant.

If your provider participates and accepts assignment (we do), you just need to provide your Medicare card, any supplement insurance cards you have, your date of birth and your signature on the Medicare form.

After your Medicare deductible has been met, Medicare will pay for 80% of your lenses (single vision, bifocals or trifocals). Medicare also pays 80% of the allowed amount toward your frames.

What if I have supplement insurance?

If you have supplement insurance and Medicare pays for your glasses, that insurance (in most cases) will reimburse you the remaining 20% of covered charges, after Medicare pays your claim.

What part of the charges am I responsible for?

In addition to your deductibles and copayments, you will be responsible for lens and frame options that are not within the guidelines that Medicare has provided. For example: Medicare covers Progressive lenses, but they will not approve the full amount. They will pay the same as a lined trifocal. You would be responsible for the difference.

I hope I have provided you with some understanding of how your Medicare coverage works with your eyeglass needs. Rest assured that while you are here at our office we will take the time to go over all your questions and make sure you fully understand what you are responsible for as well as what you should expect from your Medicare and supplement insurances.

*please note that Medicare HMO is handled differently than traditional Medicare. Refer to your benefits for Medicare HMO coverage explanations*