Vision plans: exams, lenses and frames

Part B covers ophthalmology when it treats disease: cataract surgery, glaucoma testing for higher-risk patients, diabetic retinopathy screening, and injections for macular degeneration. Those are medical services, and they are covered on the same terms as any other Part B care.

What Part B does not cover is the routine refraction that produces a prescription, the lenses themselves, frames, or contacts. Glaucoma screening is covered only for people at higher risk, which means many patients pay for that test themselves unless a plan covers it.

A typical plan covers one exam a year at a fixed copay, an allowance toward lenses, and an allowance toward frames that resets every year or two. Many add a discount on a second pair and on laser vision correction.

The benefit amounts are smaller than dental, and that is fine: the underlying costs are smaller too. The value is in frequency. Two pairs of glasses in a year without coverage can easily cost more than the annual premium.

If you have cataract surgery, Medicare pays the surgeon and the facility, and the intraocular lens that replaces your natural one is covered as part of the procedure. Upgrades, such as a premium lens that corrects astigmatism, are usually your cost.

Your vision policy can then cover the glasses you need afterward. Tell the optical shop which coverage is primary for which service, because the two do not coordinate automatically the way two health plans would.

If you already wear glasses or contacts, a vision policy usually pays for itself in the first year. If your eyesight is stable and you replace glasses every few years, a discount arrangement may be enough, particularly if your Advantage plan already includes an allowance.

If you have diabetes, glaucoma or a family history of macular degeneration, the more important coverage is your medical care. A supplement or an Advantage plan that keeps those specialist visits affordable matters more than a frame allowance.