Page Reviewed / Updated - February 07, 2020
Written By: Lauren Thomas
Medicare Advantage is a supplemental insurance plan that many seniors use to manage their Medicare benefits in a single, simple package. Medicare Advantage plans combine all the benefits of Original Medicare Part A, which pays for inpatient hospital care, and Part B, which provides for outpatient office care. Most Medicare Advantage plans also provide extra benefits, such as prescription drug coverage and vision care. Seniors who find a Medicare Advantage plan that suits their unique health needs often get the protection they want for a single monthly premium.
The purpose of this guide is to inform readers about how Medicare Advantage differs from Original Medicare in benefits and monthly premiums. It explains how Medicare Advantage works and what is typically covered by most plans. This guide is also meant to help seniors and their loved ones find a plan that meets their needs.
Medicare provides health insurance for eligible seniors in the United States. Coverage is split between several parts, according to what is being covered. Medicare Part A covers the cost for inpatient care given in a hospital setting. There is no premium for Part A coverage, and almost all costs are covered at the point of service. Because of this, Part A is automatically assigned to eligible seniors when they turn 65. Part B covers much of the cost of outpatient care, such as office visits and a limited number of medications. Part D is Original Medicare's prescription drug benefit, which pays for most of the cost of self-administered medications.
Unlike Part A, Medicare Parts B and D are not free. As a result, seniors have the ability to opt-out of these plans in favor of a private insurance plan. These plans, which are often called Part C or Medicare Advantage, provide all of the benefits of Parts A and B, along with several extra features many seniors want included under a single monthly premium. Federal law requires all authorized Medicare Advantage plans to cover the same services as Parts A and B, though there is variety in the other features plans offer.
Beneficiaries can opt-in to a Medicare Advantage plan when they become eligible for Original Medicare benefits, or they can sign up for a plan during the annual open enrollment period that runs from October 15 to December 7 each year. Most Medicare Advantage plans charge a monthly premium that ranges between $0 and $300 a month, which varies with plan specifics and geographic area. The average Medicare Advantage plan in the United States costs participants $29 a month, plus any upfront costs that exist at the point of service.
Not every Medicare Advantage plan includes vision care, but the option is available under many plans in all 50 states. To get vision coverage under a Medicare Advantage plan, it is first necessary to be eligible for Original Medicare. To qualify for Medicare, U.S. citizens must be either aged 65 and older, be receiving Social Security Disability Insurance (SSDI) for at least the previous 24 months continuously for a medically diagnosed disability, or suffer from end-stage renal disease. Hospice patients are also eligible for Original Medicare Part A coverage.
If you meet the eligibility criteria for Original Medicare, you can choose to forego traditional coverage options and instead buy a Medicare Advantage plan from a private insurer. Every state has at least one authorized Medicare Advantage provider, and most states have more than one. Applications can be made directly through the company that offers the policy you're interested in, or you can apply for a Medicare Advantage plan through your state's online health insurance marketplace. While reviewing plans, be sure to look for the stated vision care options, which are not automatically included in all plans. If a policy you're interested in does not specifically state it includes eye exams and prescriptions for glasses, call the company before you sign up to find out if you can get the coverage. Some insurers are willing to expand the coverage of a plan with a supplemental option if you ask. Other plans include vision care, which should be listed as a coverage option in the policy documents.
Q: Does Original Medicare pay for eye exams?
A: No. Original Medicare does not include a vision plan. Without a supplemental insurance policy, you must pay 100% of the cost of all vision care. The only exception is eye treatments that are performed while you are a patient in a hospital, or that are incidental to other health issues, such as surgery to repair injury.
Q: Does vision care add to the price of a Medicare Advantage plan?
A: The extra coverage some plans offer for vision care may add to the final monthly premium of your plan, though some include vision at no extra cost. Some Medicare Advantage plans charge a monthly premium of $0, and so their vision coverage is provided at no cost to participants.
Q: Do I have to pay anything for vision care with a Medicare Advantage plan?
A: Depending on the details of your Medicare Advantage plan, you might have 100% of your costs covered by the monthly premium. Otherwise, you might be expected to pay some of the cost of your exam and prescription glasses at the point of service as a co-payment. Some plans also have an annual share of cost that must be paid before they provide any benefits at all. If you have already paid your share of cost for the year, the remaining costs should be included under your insurance.
Q: What kind of glasses are paid for by a Medicare Advantage plan with vision coverage?
A: The details of what your plan covers vary with the state, the company and the policy you have chosen. Some plans offer comprehensive coverage for most types of glasses, while others pay only a fraction of the cost. Some place restrictions on how often you can see the optometrist, and some will pay only for the most basic frames and lenses, leaving optional costs up to you. Ask your insurance company about what your plan pays for before you commit to an option.
Q: Do Medicare Advantage vision plans pay for blended lenses, sunglasses or other premium options?
A: Medicare Advantage plans are highly variable in the extras they offer, beyond the required minimum of hospitalization and office visits. Some vision plans pay some or all of the cost of extra features, while others do not. Speak with your insurance carrier about the details of your insurance coverage before deciding on a plan, or before receiving services you may have to pay for from an optometrist or optician.
Q: Can I change vision plans if I have Medicare Advantage?A: Medicare Advantage customers are allowed to change coverage during the annual open enrollment period, or during a special enrollment period for those who qualify. You may be able to change plans without a penalty rate if you have recently lost your prior coverage due to a change in employment or the previous insurer declaring bankruptcy, if you have just returned from overseas or if you have been recently released from a federal institution. Check with your Social Security office for details about changing your Part C coverage.