Monday, August 3, 2009

Eyeglass Coverage by Medicare...

Thanks to my good colleague Daphne Apostle for providing the following. It is great information particularly for folks who used to rely on Medi-Cal for their vision requirements.

Eyeglasses and Contact Lenses
How Do I Qualify For Eyeglasses or Contact Lenses After Cataract Surgery?
Normally, Medicare doesn't cover eyeglasses or contact lenses.

However, following cataract surgery with an intraocular lens, Medicare helps pay for cataract glasses, contact lenses, or intraocular lenses provided by an ophthalmologist. Services provided by an optometrist may be covered, if the optometrist is licensed to provide this service in your state.
Important Note:
• Only standard frames are covered.
• Lenses are covered even if you had the surgery before you had Medicare.
• Payment may be made for lenses for both eyes even though cataract surgery involved only one eye.
There are several provisions regarding coverage.
• Medicare covers glasses or contact lenses for patients who have had cataract surgery and an intraocular lens implant. Medicare will cover these items even if the patient had surgery before Medicare benefits began.
• Medicare will cover one pair of glasses or contact lenses following cataract surgery. Medicare only covers standard frames.
• An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.
• Make sure your supplier is enrolled in Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for a Medicare supplier number. Medicare won't pay your claim if your supplier does not have a number, even if your supplier is a large chain or department store that sells more than just durable medical equipment (DME).
What Will Eyeglasses or Contact Lenses Cost Me if I just had Cataract Surgery?
How much you pay will depend on what type of coverage you have and where you buy your glasses or contacts. These items are covered under Medicare Part B. However, in general, if you are enrolled in Medicare:
• After you have paid your yearly deductible, you will pay 20 percent of the approved Medicare amount for the cost of the eyeglasses or contact lenses.
• You will pay less if you buy from a supplier who accepts assignment. A supplier who accepts assignment has agreed not to charge more than the Medicare allowed amount and will not charge more than the 20 percent co-pay.
• If you have a Medigap/supplemental policy, you might not pay anything for your supplies.
• If you receive your Medicare through a Medicare Advantage Plan, you may owe little to nothing depending on the plan with which you have signed up and your benefits with the plan.
It is important to do your homework. Read about the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through an approved supplier that accepts assignment.

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