Medicaid, Medicare, and Vision Care

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Do You Need Vision Insurance?

It is important to have good medical insurance to maintain your health. The decision to purchase vision insurance can be complicated since many aspects of eye care are not covered by regular medical insurance.

Generally speaking, eye care that is related to an overall medical condition falls under your healthcare policy. An example of this would be where a doctor deems an ocular exam necessary for a diabetic with high blood. In such circumstances, medical insurance may cover the cost of an appointment with an optometrist under the framework of general health.

Some medical insurance plans offer supplemental plans to cover eye care. Others combine vision and dental care coverage as a package. Depending on your individual needs, you will need to determine if it is a worthy investment. For those who require extensive vision care, the costs can add up. Vision insurance may be the way to go.

The Beginner's Guide To Vision Insurance

There are many different kinds of vision insurance on the market, and they all have their own benefits. Plans may offer the following benefits:

Coverage for contact lenses or prescription glasses, either free of cost or at a reduced price.
Coverage for annual exams
Copayments and deductibles saving you money for the overall cost
Top tier plans often feature partial coverage for surgical ocular procedures

How Much Does Vision Insurance Cost?

Prices vary depending on how extensive the plan. Simple plans can be as low as $10 monthly. Higher tier plans can cost as much as $30 monthly but may offer top-tier benefits such as discounts on corrective surgery such as LASIK.

Things To Consider

When shopping around for a vision insurance plan consider the following:

your personal medical profile and individual needs
monthly cost
cost of copayments or deductibles
company rating
types of benefits, including the cost of prescription lenses and frequency of benefits
Identifying visual-motor and neurological deficits and implementing corrective measures including a rehabilitation plan of Vision Therapy

Are Medicaid and Medicare Viable Options For Vision Care?

Medicaid and Medicare are federal and state programs providing assistance and insurance for seniors and people with a low income. While neither program offers extensive vision care, speak with state providers to see if you are eligible and to determine if they provide viable options for you.

Medicaid

Medicaid is run jointly as a federal-state program providing medical assistance to anyone with a low income regardless of age. The benefits vary by state, and it is either free or available with partial payments. Benefits include the following:

As part of The Early, Periodic, Screening, and Diagnostic Program (EPSDP), states provide glasses and eye exams for children and young adults. The amount of coverage depends on what is deemed medically necessary. Benefits vary by state.
Does not cover surgeries for refractive error

Medicare

Medicare is a federal program providing medical insurance for all seniors regardless of income, including younger disabled people. The cost is low, either in the form of low monthly premiums for non-hospital care and deductibles. Medicare does NOT provide coverage for routine eye exams, and in most cases, it will not cover contact lenses or glasses. However, it does offer the following benefits:

An annual exam for diabetics and those at high risk for glaucoma
Coverage for certain procedures, tests, and surgeries for ocular diseases and conditions
Eye exams to check for serious conditions
Medicare Part B offers coverage for glasses following cataract surgery if you had an intraocular lens attached post-surgery

Do You Need Vision Insurance?

Do you have poor vision and require frequent examinations that aren't covered by medical insurance?
Will you be purchasing prescription glasses or contact lenses during the year?
Are you considering corrective surgery?

Generally speaking, Medicaid and Medicare provide limited benefits for vision. For those with a limited income, contact a state Medicaid or Medicare provider to find out if they offer viable options that match your needs.

Common Questions

What is the difference between medical and vision insurance?

Vision insurance typically is used for eye exams, frames, lenses and contacts whereas medical insurance is generally used only for exams that have a medical nature such as dry eye or another medical diagnosis.

Does medicaid cover vision therapy?

Eye conditions such as amblyopia, strabismus, convergence insufficiency and binocular vision dysfunction are treated in vision therapy. These conditions are classified as medical issues rather than refractive errors, and therefore would normally fall under medical insurance as opposed to vision insurance. However, as each diagnosis and medical insurance have their own regulations about what is covered in each circumstance, it is impossible to give a standard answer to what is covered by every plan. Therefore, depending on the type of eye condition and plan, Medicaid may cover vision therapy.

Everyone's medical requirements are different. Vision insurance isn't right for everyone. However, for those who require more extensive vision care, a good insurance plan can save them a lot of money.

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Testimonials

At Amplify with Dr Wernick I was seeking help for seemingly intractable, probably age-related dryness. I've seen other doctors about it, and that has been helpful, but what he explained to me about it and the careful way he answered all my questions gave me so much more of a clear understanding of what is going on (and is not) that I am more able to implement all his and others' recommendations than I was before. And he gave me additional resources for further follow-up. I am most grateful.

Cynthia Norton

Wow! This is a great Eye Care medical facility. I was thoroughly examined by Dr. Pinkhasov for over 2 hours. She made sure to check my eyes for pretty much everything and patiently explained proper care for my eyes. They definitely know how to provide great care and treat their patients right. Now I know why they have such a great reputation and been around for so long.

Steve Fay

Dr. Kavner is a gifted diagnostician and orthoptic therapist. He treated me several decades ago for a condition similar to dyslexia. I was having migraines five times per week. I worked with him for about a year and I experienced tremendous improvement (down to 3-4 per year) that has lasted.

Mary K.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!

Peter G.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!

Kinkie F.

I have always found Dr Kavner's work, expertise and wisdom of the highest caliber. As one of the fathers of OT, occupational othomology, his depth and breadth of knowledge about the eyes' health and wellbeing of the patient is exemplary. Cannot say enough good things about him.