Protecting your vision is an important part of your overall health.
Many of our Medicare Advantage plans include vision benefits. We know that you may have questions about your vision coverage. We're here to answer your questions and break it down for you. Let's get started!
What's Included in My Vision Benefits?
Depending on your plan, your vision benefits may include:
- A yearly routine eye exam
- Glaucoma prevention care
- Diabetic eye exams, also called retinal exams
- Glasses and contacts
Where Can I Find Information About My Vision Benefits?
You can view details about your plan's vision benefits in your Summary of Benefits document in the secure member portal. You can also find it on your health plan website under the Members section.
If you have any questions about your vision benefits, call the phone number listed for vision on the back of your Member ID card. They can review your plan benefits and help answer your vision questions. You can call between 8am and 8pm Monday through Friday.
Are Glasses and Contacts Covered?
You can see what's covered by your plan on your Summary of Benefits. Some plans include a dollar amount that you can use towards glasses and contacts.
How Do I Find an In-Network Eye Doctor?
It's important to make sure that your eye doctor is in your plan network. Using an eye doctor that's in the plan network means lower costs for you. If you see a doctor that isn't in the network, the services might not be covered by your plan, and you may have to pay more out-of-pocket.
To find an in-network eye doctor near you, visit the secure member portal and use the Find a Provider tool. Remember you can also call your vision vendor using the number on the back of your Member ID Card.
When Should I Visit an Eye Doctor Instead of My Personal Doctor?
You should visit an eye doctor for your vision and eye care. For example, you should visit an eye doctor (also called an optometrist) if you notice a change in your eyesight, you're having problems seeing things or if you have pain in your eyes. The optometrist can do eye exams, prescribe glasses, write prescriptions and diagnose eye issues. The eye doctor can also refer you to a specialist if you need to see one.
What Happens at an Annual Eye Exam
During your annual eye exam, your eye doctor will perform different tests to check your vision and look at your total eye health. You should get an eye exam every year. If you have other medical conditions, like high blood pressure or diabetes, your doctor may recommend you have additional eye exams.
What if I Need To Go to a Specialist for a Procedure, Like Cataract Surgery? Will That Be Covered?
Make sure the specialist is in your plan network. To find an in-network specialist near you, visit your secure member portal and use the Find a Provider tool. Check your Evidence of Coverage to see what special procedures are covered by your plan and how much you may need to pay out-of-pocket.
What if I Need Cataract Surgery or Post-surgical Glasses?
Your eye doctor may refer you to an eye surgeon for cataract surgery. Ask your doctor to refer you to an in-network surgeon who accepts Medicare.
Your surgeon can talk to you about cost and coverage before your procedure. If you need post-surgical glasses after your cataract surgery, these may be covered by your medical insurance, not your vision benefit.
How Do I Pay for My Vision Services?
Your Member ID card is the key to receiving the care you need. Remember to always bring it with you to every appointment. For any dual Medicare and Medicaid members, be sure to carry both cards with you at all times as they each serve a unique purpose.
Will I Get a Separate ID Card for Vision?
You only need to use your health plan Member ID card. There isn't a separate vision card.
To recap, you should call your vision vendor if you need to find an in-network eye doctor, have questions about your vision benefits, including covered services and procedures or have general questions about glasses or contacts.
Additional Questions?
Call Member Services if you have general questions about your plan or have other benefit questions. From April 1 - September 30, you can call between 8am 8pm Monday through Friday. From October 1 - March 31, you can call between 8 am to 8 pm every day.
Thank you for trusting us with your healthcare needs. We appreciate you being a member, and hope this information helps you better understand your vision benefits.
