Eye Glasses Insurance Coverage

Beth Gallagher

Beth Gallagher

Well-known member
We have glasses coverage with our Medicare Advantage Plan and use it annually for a "free" eye exam and payment toward new glasses. I went to the optometrist today and when it was time to go over the options on my new specs I was informed that our coverage has been reduced this year. The exam is still fully covered, but they are paying less on frames, lenses, and add-ons like photogray or protective coatings.

At first she priced a pair with all the upgrades; thin lightweight lenses, wider progressive lens 'corridor' coverage, blue screen, anti-glare, blah, blah. Those were about $1300 and my out of pocket was going to be $530. I told her no way am I paying that, especially since I may be having cataract surgery in 6 months.

So we looked at options, staying with the thinnest lenses because I have to have lightweight glasses or I won't wear them. Left off most of the coatings and went middle of the road with the progressives, etc. Final out the door cost to me was $327 and then I had her delete the "hazard insurance" which was $45 for 1 year, so $282.

The total cost of those downgraded glasses was about $1000. I don't know what the insurance negotiated price was; only that I paid $282. What a racket.
 
Our vision coverage with Devoted decreased this year, too.
Last year, they gave us a $500 card that was for dental and eyeglasses, but this year, they upped the dental coverage and reduced the eyeglasses coverage, so after reading all the information for advantage plans online, and then talking with our Medicare insurance agent, we switched back to Humana for this year since they had more for the vision benefit.

The actual eye exam is considered part of health and is covered by Medicare, to check for glaucoma, cataracts, etc; but getting new glasses is not covered under Medicare, so the advantage plans can determine what coverage they want to give you for vision. Each year there can be plan changes, either for better coverage, or for less, depending on the company and the plan you are eligible for.

For some reason, Humana put us both on their SNP (special needs plan) like we always have, but then they sent a letter to Bobby, telling him that he does not qualify for that plan for some reason. When he called Medicare, his QMB was the same, so it must have been something that Humana changed in their eligibility process.
Anyway, we are both changing back to Devoted Health, starting in March, so Bobby is going to America’s Best this month to get his new glasses while he still has the higher Humana vision benefit.

Every fall, when the open enrollment takes place, you can look on the website for different Medicare advantage plans and compare plans. The company that you are with will send out a “notice of changes”, which explains what will be different in the upcoming year. That is how I discovered that Devoted has less vision benefit for 2026 than they did in 2025. They will probably adjust it again this fall if they lost other customers because of the vision benefit change.
 
I do not understand where the racket comes into play. Contracts change depending on negotiations and markets. We have our annual check ups and new glasses generally around October.
 
Yvonne Smith said:
Every fall, when the open enrollment takes place, you can look on the website for different Medicare advantage plans and compare plans. The company that you are with will send out a “notice of changes”, which explains what will be different in the upcoming year. That is how I discovered that Devoted has less vision benefit for 2026 than they did in 2025. They will probably adjust it again this fall if they lost other customers because of the vision benefit change.
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Since my husband and I both retired from a large corporation, we get our medical, dental, and vision insurance as part of a negotiated group plan. It is supposedly the best deal due to the size of the group so we just let it rock along.
 
I'm very glad that a woman who works at the Social Security office in Eureka clued me in on Advantage plans. She said they are essentially a waste for Californians, as my base Medicare plan covers everything I need for vision care except glasses. However, if I really need a pair of prescription glasses, they are covered by Medi-Cal. My Eye Doc and my old Pharmacist said because my eyes are the same, I can use readers. A three pack of those at Costco is $15 now, when they put them in their monthly coupon book, $20 when they aren't in the coupon book. I bought three packs at different strengths, in Eureka back in 2021 when they were $12 / $17 a pack. 2.00, 2.50 and 3.00 magnification. If I can't see with 3.0, a pair of prescription glasses are covered by Medi-Cal. And they say by the time that happens I'm be legally blind and glasses might be fully covered then.

I also have full dental coverage from Medi-Cal as well. It used to be kind of slow to get Dentures because they would only agree to two extractions per visit, per month. I was in the process of doing that and was down to 8 teeth left, 5 on the bottom, 3 on top. When the Pandemic lockdown started, the office I went to closed temporarily. By the time they opened again, I didn't live in Eureka anymore. While I was in a diabetic coma, someone who changed my intubation tubing at St. Joseph's Hospital broke one off at the bottom, and another one them in half, leaving 6 and a half left. Both are on top. The last time I called Medi-Cal about finishing the agreed upon procedure I was told that it had been approved by "Partnership", my HMO in Eureka, and was no longer valid. Now that I live in a different County, I would have to start all over again. So I decided to have the 2 and a half left remaining ones on top taken out and get dentures for the top. That way I could at least eat stuff that isn't "baby soft", or cut up so small it can be "gummed to death"... The bottom 5 were the best of the lot when I started this.
 
Axel Slingerland said:
I'm very glad that a woman who works at the Social Security office in Eureka clued me in on Advantage plans. She said they are essentially a waste for Californians, as my base Medicare plan covers everything I need for vision care except glasses. However, if I really need a pair of prescription glasses, they are covered by Medi-Cal.
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I believe there is a similar program in Texas called "STAR", but I'm not familiar with it since we don't qualify for it.

We have been very pleased with our Advantage Plan through Aetna. It is widely accepted and I believe the copays/out of pocket costs are reasonable. When I had cancer treatment at MD Anderson it cost nearly half a million dollars, but our cost was $3000.
 
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