Finding a nearby eye doctor who accepts Medicare saves on travel and out-of-pocket expenses but is not always straightforward.
Accepting Medicare assignment means the provider takes the approved amount as full payment for a covered service. They charge only the deductible and coinsurance if applicable.
Medicare Part B (medical insurance) does cover vision care, while Part C (Advantage Plans) sometimes includes limited benefits. Therefore, the search strategy for optometrists depends on your coverage type.
Medicare Parts A & C cover diagnosing and treating eye diseases because it is health insurance. However, you must use the correct provider directory to find ophthalmologists who take your plan.
Optometrists Accepting Medicare
Finding local optometrists that accept Medicare assignment can be tricky because Part B does not include vision benefits, while Advantage Plans sometimes do. An optometrist is an eye doctor focused on detecting and correcting refractive errors.
Vision Exams
The answer to which optometrist accepts Medicare for eye exams to detect and measure refractive errors is binary based on whether the senior citizen or disabled adult has Part B or C.
Zero optometrists accept Medicare on vision exams for patients with Part B because their plan does not cover the service. You might need to find an alternative.
- In many states, Medicaid covers vision exams, meaning dual-eligible seniors for the two programs might find a long list of optometrists accepting Medicaid reimbursement as full payment.
- Optometrists accept Medicaid only in the states that support benefits, so you must research the rules before booking an appointment.
Numerous optometrists take Medicare Part C for vision exams because many Advantage Plans include coverage for the service. The issuing insurance company will publish an online directory listing in-network providers, which you should use.
- Aetna
- Blue Cross Blue Shield
- Humana
- United Healthcare (AARP private label)
Eye Glasses
The answer to which optometrists accept Medicare for eyeglasses is murkier because Advantage Plans sometimes include vision benefits, while Part B covers corrective lenses for only one specific reason.
- Medicare Advantage Plans often include eyeglasses as a benefit, and patients should consult the online provider directory noted in the section above to find a local optician participating in their plan.
- Medicare Part B covers corrective eyewear if you have cataract surgery that implants an intraocular lens. If so, it will pay for one set of eyeglasses with standard frames or one set of contact lenses.
As you will see next, the ophthalmologist performing the cataract surgery can outfit you with eyeglasses after the procedure, making this specialist more affordable than an optometrist or optician.
Ophthalmologists Accepting Medicare
Finding local ophthalmologists accepting Medicare assignment is often much more manageable because Parts B and C cover diagnosing and treating many eye diseases. An ophthalmologist is an eye doctor who performs medical and surgical treatments.
Part B
Senior patients with Medicare Part B coverage can readily find local ophthalmologists accepting assignment through the federal provider directory.
Medicare Part B covers diagnosing (exams) and treating eye diseases such as glaucoma, cataracts, diabetic retinopathy, and macular degeneration.
Find nearby ophthalmologists accepting Medicare online at the government-run website. Enter your zip code in the “My Location” box and click on the “Name & Keyword” box, and the form will populate with popular searches such as the following.
- General practice
- Psychiatry
- Internal medicine
- Dermatology
- Ophthalmology
- Orthopedic surgery
You know what to do from there.
Part C
Seniors seeking nearby ophthalmologists who accept their Medicare Part C Advantage Plan sometimes encounter difficulties. The online provider directory published by the issuing insurance company may have fewer entries.
Medicare assignment rules do not apply to Advantage Plans. Instead, these plans work like Preferred Provider Organizations with narrow networks of participating offices that take the negotiated allowed amount as full payment.
Please do not reference the Medicare-supported provider finder if you have Part C. The listed ophthalmologists might accept assignment but not participate in-network with every Advantage Plan.
Instead, reference your insurer’s online portal. You might find ophthalmologists listed in the doctor section, the vision section, or both.
- Aetna
- Blue Cross Blue Shield
- Humana
- United Healthcare
LASIK
Finally, finding local ophthalmologists who accept Medicare for LASIK eye surgery injects two additional wrinkles into the equation. LASIK (Laser-Assisted In Situ Keratomileusis) surgery corrects refractive errors such as myopia, hyperopia, and astigmatism.
- Part B does not cover LASIK because it is a vision service. Therefore, you will not find a provider accepting assignment.
- Part C might cover LASIK, but the price will overwhelm the average annual benefit limit of $200. Therefore, you will have to pay the majority of the cost.
LASIK financing without a credit check could provide the money (up to $2,500 per eye) needed to correct your visual acuity problems surgically. Medicare will not reduce costs much, regardless of whether you have Part B or C.
