Eye care in Maine

Ken Anderson

Ken Anderson

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Staff member
When we first moved to Maine, it was possible to get a walk-in visit at an eyecare facility. We had an optometrist here in Millinocket, and there was even one at the mall. The optometrist in Millinocket retired several years ago and no one took his place. I had one that I went to in Bangor for many years but I had an appointment to see him a couple of years ago, only to find, after driving more than 60 miles to Bangor, that he wasn't in "because of a family emergency."

They told me they had tried to call me, but they hadn't really, unless "trying to call me" meant calling someone else's number. I was pretty upset and decided to find another optometrist, but I couldn't. None of the other vision care places in Bangor or nearby were taking new patients. I could still see well enough, and managed to pass the test to renew my driver's license, which is what I was concerned about, even without my glasses, so I forgot about it.

Now, it's past time for a new prescription, though, and I still can't find a vision care clinic that is taking new patients. This include a rather bizarre interaction with one vision care place. They wanted my Medicare information, and then didn't seem to understand that my Advantage Plan was my Medicare information, and wouldn't even make an appointment without whatever it was that they were looking for in Medicare information. This was despite the fact that I'm willing to pay for full costs myself. No, without "Medicare information," they wouldn't schedule an appointment. I've worn glasses since I was ten; would that mean that I'd have to wait until I was old enough to to qualify for Medicare before I could get an appointment? I don't get it.

In the process, I learned that the "family emergency" that my last optometrist was dealing with a couple of years ago was that he had died. There's a new optometrist at that office now but the faciliity has a new name and I am not registered as a patient.
 
When I went to see my optometrist in Eureka, California, he says "You're lucky. You eyes are fine for using readers", and I haven't bothered with prescription glasses ever since.
 
On our Medicare advantage plan, we have an annual eye exam included. The eye exam checks for things like glaucoma, cataracts, and stuff like that, and it is included with the medical part of the plan. This year (2025), we have Devoted Health, and they gave us a $500 card, like a Visa card, that can be used for glasses or dental care, and I used mine for new glasses.

There was enough money on the card for 2 pairs of glasses from America’s Best, which is one of the places that you can use the Advantage card. I was only going to get one pair, because I mostly use reading glasses in the house for reading, and wear my old pair of glasses in the car to help read road signs, etc.
The lady explained to me that they can make one pair of glasses for reading, which I had no idea could even be done.
So, they are like regular reading glasses, except they are corrected for my astigmatism. She said they would help me to see much better for reading , iPad painting, and doing things on the computer.
The other set will stay in the car for distance vision and reading road signs.

For some reason, Devoted upped the dental care amount, and dropped eye care to $100 for 2026, which is not much for glasses, and Bobby will need new glasses next year; so we have changed back to the Humana Advantage plan, which allows $400 , if I remember right, enough to pay for new glasses .
We are really happy with the America’s Best people, and definitely recommend using them if you have an advantage plan that includes them, and there is one close enough to go to.
 
Yvonne Smith said:
On our Medicare advantage plan, we have an annual eye exam included.
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So does mine, along with a portion of new glasses but for reasons unfathomable to me, the only vision clinic/eyecare facility I can find that is taking new patients doesn't seem to have every heard of an Advantage Plan, and for other reasons that I can't understand, they refuse to make an appointment without my Medicare information. I could let them see my Medicare card but that won't pay anything on my eyeglasses so that doesn't make a bit of sense to me. If they won't schedule an appointment for anyone who isn't on Medicare, I'd think they'd know what an Advantage Plan is. I am so confused.
 
On the Devoted website, and also on Humana, they have a list of providers, and that shows all of the doctors of every kind, that accept this insurance.
If you look on the website or app for whomever provides your Medicare advantage plan, it should show you which doctors accept that coverage. What company is your plan with, @Ken Anderson ?
 
Ken Anderson said:
So does mine, along with a portion of new glasses but for reasons unfathomable to me, the only vision clinic/eyecare facility I can find that is taking new patients doesn't seem to have every heard of an Advantage Plan, and for other reasons that I can't understand, they refuse to make an appointment without my Medicare information. I could let them see my Medicare card but that won't pay anything on my eyeglasses so that doesn't make a bit of sense to me. If they won't schedule an appointment for anyone who isn't on Medicare, I'd think they'd know what an Advantage Plan is. I am so confused.
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Sounds a bit like a medicare scam may be involved.
I went to get an eye exam here at our medical industrial complex because my hubby told me to. The Dr was new and I was new to him. He said I 'could be' getting cataracts.
???
I could be winning the lottery too. Then he said I should set up an appointment for next year.
I don't do that. I call if I need something. He didn't recommend glasses. I use readers.
We used to have an opthamalogist at Walmart. For about 50 years. He left recently and no one replaces him.
There are satelite clinics popping up all over out area. Not sure why.
 
I would just like to say that it is a good idea for seniors to have eye exams even if you don't feel that you need new glasses. I went for an exam over a year ago and the optometrist found a bleed in my eye; I wasn't even aware of any problem because it wasn't affecting my vision. I was referred to an ophthalmologist who did a thorough exam and found my vitreous detachment.

For several months he monitored the bleed since many times the detachment resolves on its own. Then he tried an injection which helped temporarily, but eventually it became apparent that I needed surgery before the "stuck" detached piece damaged my retina permanently.

All to say that I had no outward signs that anything was wrong until my vision started deteriorating. No pain or anything, though the "floaters" were getting worse. So get those eye exams!
 
The point is this: my concern isn't over who pays for the evaluation and prescription. My previous Advantage Plan didn't pay for eyecare, or paid very little on it, I don't remember for sure, but I paid the bill myself. All I want is an appointment for the evaluation, and I'll pay for it myself if I need to. They are the ones who are obsessed with Medicare.
 
Yvonne Smith said:
This year (2025), we have Devoted Health, and they gave us a $500 card, like a Visa card, that can be used for glasses or dental care, and I used mine for new glasses.
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If you translate that to plain English, it means you have limited coverage. But for me, I don't need a Medicare Advantage plan. The consensus around here is that Medicare Advantage Plans are a scam.

My readers are made by Foster Grant, which are pretty good quality. At Costco you get three pair for $20 or $16 if they are in the Costco Coupon Book, which they are at the moment. If they are full price, they're $6.66 a pair, but when they are in the Costco Coupon Book, they're $5.33 a pair. I'm still using the first of three pair I bought in Eureka in 2022 as my main glasses (the full price at that time was $18), I have one pair in the glove box of the car, and the last pair is in my "trunk bag" of my Cadillac. (It's actually a fanny pack strapped on the seat of my wheelchair.) In 2022, Costco also had 2 pairs of Foster Grant sunglasses (non-readers), I'm still using the ones I started with and the other pair is in the trunk bag, as we learned the hard way not leave sunglasses in the car around here, specially in the Summer.
 
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Ken Anderson said:
The point is this: my concern isn't over who pays for the evaluation and prescription. My previous Advantage Plan didn't pay for eyecare, or paid very little on it, I don't remember for sure, but I paid the bill myself. All I want is an appointment for the evaluation, and I'll pay for it myself if I need to. They are the ones who are obsessed with Medicare.
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Sorry the thread drifted a bit, but honestly... you are probably the only one here who knows anything about eye care in Maine. I hope you are able to find a facility that will schedule your exam. Like I said in my other post, eye exams are important for reasons beyond eyeglasses.
 
I did read it. But my dyslexic brain sometimes switches things around. I thought you said you were from Bangor... Sorry. In any case, regardless of where you live, I'm pretty sure there's still a cause in the Social Security Act that makes paying cash for covered services illegal. I used to have a link for it but they moved it, and I forgot to bookmark it. But it should be easy enough to find it.
 
Ken Anderson said:
The point is this: my concern isn't over who pays for the evaluation and prescription. My previous Advantage Plan didn't pay for eyecare, or paid very little on it, I don't remember for sure, but I paid the bill myself. All I want is an appointment for the evaluation, and I'll pay for it myself if I need to. They are the ones who are obsessed with Medicare.
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Did you just give them your actual Medicare card, @Ken Anderson ? I am not sure why they didn’t want your Medicare advantage card either, but we have found that some doctors seem to not understand much about Medicare advantage, and we just show them whatever cards they ask for.
Or, sometimes, we just ask whether they take Humana/Devoted, etc insurance, and if they do, then we give them the insurance card.

Usually, I can just look on the insurance website and it shows me doctors nearby who take that insurance, and whether they are taking new patients, and then I call them and verify that.
Even so, different offices do different things. One clinic, from the local hospital, was on the list, and accepted us , but then said that we could only see the nurse practitioner, not the doctor, so I started looking for a different doctor.

If all that is stopping them from making you appointment is to show them your Medicare card, then just doing that should take care of everything, since you do not care if the insurance pays for it or not.
A quick call to your insurance company should tell you if that doctor is in your plan, or if not, which doctors are in it, if you do not want to look on their website for doctors for vision care.
 
Axel Slingerland said:
I did read it. But my dyslexic brain sometimes switches things around. I thought you said you were from Bangor... Sorry. In any case, regardless of where you live, I'm pretty sure there's still a cause in the Social Security Act that makes paying cash for covered services illegal. I used to have a link for it but they moved it, and I forgot to bookmark it. But it should be easy enough to find it.
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What I meant was that, in the OP, I said that this was the only eye care facility I had found nearby, which includes Bangor and vicinity, that is taking new patients.

What I can't understand is why are they obsessing over the payment part of it when I'm calling for an appointment? What if I didn't have Medicare? Would I have to wait until I qualified for Medicare before getting an eye exam? I'll pay for it myself if I have to. I don't want to give them my Medicare card because, besides the fact that they shouldn't need it, I don't want them to bill Medicare directly when I have an Advantage Plan.
 
Well, I did some diggin' and looked this up for you. The reason why Medicare patients paying in cash is not allowed is that it's prohibited by Section 1848(g)(4)(A) of the Social Security Act, which states that Medicare requires Doctors, etc., to submit claims for all their Medicare patients for services rendered, even if they are not covered. If your Doctor's office tells you this you can't go somewhere else, as you're still on Medicare. But if they do allow you to pay, they could be fined $2,000 per violation, and kicked off the Medicare Provider Program. So if you drove all the way out here to my stompin' grounds, the same prohibition would exist. So if you want your test, you will have to give them your Medicare number. They should be able to hook you up with a referral somewhere. I had the same problem in Eureka, California where I lived for 27 years. Glasses were not covered on Medicare, period. At first, that was fine because my Optometrist gave out glasses free. But then Congress changed the Medicare coverage, and you couldn't see Optometrists anymore. That was when my eye Doc told me that I would be ok using readers.


Here's a zip of the Social Security Act, if you want a serious headache. It's much easier to read in plain English. Try searching for "Text of Section 1848(g)(4)(A) of the Social Security Act"...

By the way, I like your forum. It's got an "easier on the eyes" dark color theme. :cool:
 
::Sigh::

I don't WANT to pay for it myself. I have a Medicare Advantage plan, which replaces Medicare proper. Payments are not supposed to be submitted directly to Medicare, but to the Advantage plan. As far as I am aware, regular Medicare doesn't pay for eyecare; my Advantage plan does. I've been on Medicare for a decade now, and have always paid for my own eye care because my last Advantage plan didn't.
 
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Nobody wants to pay, but sometimes ya gotta do what'cha gotta do. I got Covid in 2022, and spent the first three months of 2023 in three different Hospitals. (Technically, it was two Hospitals and a Skilled Nursing Facility.) When I started getting those CMS reports that come out every three months, I was like "Thank God for Medicare!" The bill for all that, with all the Doctors, misc. procedures, etc., came to a whopping $400K. I'd have to give up my first born and his faithful dog too. (n)
 
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