More than 12 million adults age 40 and older suffer from vision impairment, according to the Centers for Disease Control and Prevention. That number is expected to double by 2050 as baby boomers get older. "Visual acuity deteriorates for many of us as we age," says Gregg Ratkovic, president of Medicare at eHealth, an online insurance marketplace. "That's normal, and that's what vision insurance is [for]."
Traditional Medicare's Part B only covers vision care when it's a medical condition, such as cataracts, dry eye, glaucoma or vision health related to diabetes. Medicare Part B will even pay for a pair of eyeglasses after cataract surgery. But if there's no underlying medical condition, you're on your own. Although you have several ways to get vision coverage, whether it's cost effective depends on the eyewear you need and your provider because private insurers restrict where you get care.
Most vision insurance plans cover one eye exam a year, with a fixed dollar allowance going toward eyeglasses or contacts either once a year or once every two years, Ratkovic says. The eye exam, which is performed by an optometrist or ophthalmologist, is comprehensive enough to screen for most conditions that can cause decreased vision, says Dr. Michael Repka, a professor of ophthalmology at the Wilmer Eye Institute's medical school in Baltimore.
Monthly premiums range from $11 to $40, and the insurer typically pays either $120 or $150 toward a pair of eyeglasses or contact lenses, says Barbara Davis, principal at consulting firm Health Benefit Advisors in Bluffton, S.C. Most plans will also have copays or deductibles you'll be responsible for, Ratkovic says. Many vision plans have no waiting period before benefits kick in, Davis says, but some may require you to pay premiums for a certain number of months, or even up to a year, before you can use the benefits, says Ratkovic.
A low-cost plan may be all you need, and for some people, self-insuring may be more cost-effective. Davis suggests comparing the plan's annual cost with your estimated vision costs for the year. For someone who sees an optometrist once a year and only needs a basic prescription, it's likely "a wash," Davis says.
She recommends keeping the monthly premium under $17. "That will give you a decent plan that the majority of individuals will find comprehensive enough for their annual needs," she says. "I wouldn't get into a $40 plan that has a lot of bells and whistles no one uses." The main difference between more and less expensive plans are the allowances provided toward eyeglasses and contact lenses. For instance, under a cheaper plan you may pay up to $175 for a progressive lens, which has a stronger magnification toward the bottom. Under a more expensive policy, you could pay just $50 for the same lens. Allowances for lenses that have anti-glare or scratch-resistant coatings will also be based on the cost of the plan, Davis says.
If you have multiple insurance needs, it may be more cost-effective to choose a comprehensive plan that bundles dental, vision and hearing -- none of which traditional Medicare or a supplemental medigap plan covers -- into one package. DVH plans cost $30 to $45 a month on average, have no waiting period for vision and dental preventive care, but typically delay any hearing coverage or major dental services until the second year, according to Elite Insurance Partners, the insurance brokerage behind MedicareFAQ.
For vision care, the plans usually offer graduated coverage, with the insurer typically picking up 60% of the costs of eye exams and eyewear in the first year, 70% in the second and 80% in the third; the amount covered is typically capped at about $200 the first two years, according to MedicareFAQ. DVH plans are offered only in certain states. Visit medicarefaq.com for more information.
Last year, 99% of beneficiaries in a Medicare Advantage plan had some vision benefits, according to the Kaiser Family Foundation. Almost all of those beneficiaries had the coverage amount capped, at $160 on average. That means the plans only paid for up to $160 of vision care expenses, leaving beneficiaries to shoulder the rest. The majority of these plans also covered one eye exam a year.
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