Wellness

[patbz]

We go annually to Opthomalogist and since we are over 65,there is no charge for standard checkup ( very thorough) unless I need a new prescription written ($25).  He also did our cataract surgeries and there was an allowance to buy first pair of post surgery glasses from him.  Otherwise we buy our no line progressives from Zenni and they run $65- $125, including frames ( I've done this for 25 years).

[wagirl]

@kate2357 ---that has been mentioned to me and did check it out as far as frames were concerned--not very impressed --but that was a while ago. Never have had an exam there either---good idea tho.

[kate2357]

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@wagirl wrote:

@kate2357 ---that has been mentioned to me and did check it out as far as frames were concerned--not very impressed --but that was a while ago. Never have had an exam there either---good idea tho.

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@wagirl 

The frame selection is limited and they do change what is offered all the time. If you get VSP, you can send in the information re: frames and exam to get reimbursed.

I just went on medicare this September and it's a challenge to determine how everything works in real life. I'm happy to have coverage.

[CelticCrafter]

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@kate2357 wrote:

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@wagirl wrote:

@Desert Lily --let's face it--there isn't any vision insurance that covers  much of the real life cost of glasses etc---I had amazing ins coverage when I  was married---even then the vision ins was medicore at best---will have to see what happens. My glasses--with exam, lenses and the extras that I get with them--scratch guard, non glare, no lines and frames that I try to find on  sale--usually cost me  at least $500 out of pocket---think this vision thing is a racket anyway------

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@wagirl 

Have you tried COSTCO vision centers? It is where we've been getting glasses for years. Only once did I go to a stand alone Doc and paid thru the nose. My VSP covered a very small percentage. So we've always opted for COSTCO to see the doc, get a prescription and then to fill it at COSTCO. Never paid much more than $250 for my glasses and that included all the bells and whistles.

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The last time we needed glasses we went to Costco.  

Never again.  The scratch resistant might as well say resistant to cleaning also.  Awful to try to get them clean and keep them that way.  Water drops smear on them as you try to dry them.

[wagirl]

@kate2357 ---I started Medicare the first of April of this year--I did talk to a medicare agent with the company  I have now about my needs and am not sure if I like this company or not---- and have been having issues with Medicare not changing me over from my former insurance--have had to call them 3-4 times to get that insurance removed--so maddening!! and have had to call the billing depts of the drs I had appts with so they can re- submit the bills to Medicare. this should not be so difficult!! Famous last words, right?!

[conlt]

If you have a medical condition such as Diabetes, you should be covered to see an Ophthalmologist. 

[gertrudecloset]

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@granddi wrote:

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@gertrudecloset wrote:

Does Medigap Cover Dental and Vision Care?

by Christian Worstell | Published January 19, 2022 | Reviewed by John Krahnert

While Medicare Supplement Insurance (Medigap) and Original Medicare (Medicare Part A and Part B) do not cover routine dental and vision care, Medigap plans can help beneficiaries pay for costs they may face if they get dental or vision care that are covered by Medicare. There are also other types of Medicare plans called Medicare Advantage plans that may provide routine dental and vision coverage.

The supplement plan will only cover your vision if it's medically necessary because of the diseases of the eye.  It will NOT COVER ROUTINE vision care.  Only diseases like cataracts, Macular Degeneration, being Diabetic.  Under these circumstances Medicare DOES cover your eye care.  Routinely going once a year for simple check ups for new glasses WILL NOT BE COVERED.  So with that being said, since a Supplement Plan helps to offset any approved treatment by Medicare, the Supplement can help with the cost of your vision if it's medically necessary condition and not just for routine vision testing.

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To expand this response just a little. You don't have to have an eye disease like glaucoma or a systemic disease like diabetes. A person could be experiencing: blurred vision, double vision, dry eyes, eye pain, itchy eyes, red eyes, crusty eye lids, halos around lights, poor night vision----all of these are examples of medical problems that would be considered a medical examination covered by Medicare by an MD or OD who participates in your plan. Any time the term ROUTINE is used in an insurance claim it will most likely be considered NON_COVERED and not paid. 

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Thank you! You are so right.@granddi , however since Opthamology is such a specialty that tends to treat very difficult diseases of the eye instead of a simple infection (which conjunctivities is) you wouldn't likely see an opthalmologist for that.  You'd see your primary care.  I can't tell you how many times I've had pink eye.  I hated it.  Infections are treated with antibiotics and you're fine.

However living with a major eye disease is different from say, having pink eye.  Of course, if you're walking around and you have blurred vision it behoove you to see an opthamologist.  Otherwise, no, Medicare will not pay for an eyechart exam, with refraction and a prescription for new glasses based on the deterioration of your sight due solely to old age  There must be a disease process present that effects your sight. 

Optometrists and Opthamologists both check your vision and adjust your lenses. 

Thank you for jumping in to add other conditions so that we can better understand what's at stake when it comes to Medicare and eye coverage.

Not for one minute do I believe Medicare pays for anyone to read the chart, have a regular eye exam and they tell you your vision is 20/60 and you get new glasses.  I don't care who it's for and what state they live in.  MEDICAID pays for this.  MEDICAID is State Specific, MEDICARE is not.  Advantage Plans are State Specific.  So anyone with an Advantage Plan that has typical vision coverage would get this benefit.  Otherwise, the rest of us are out of luck.

[gertrudecloset]

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@conlt wrote:

If you have a medical condition such as Diabetes, you should be covered to see an Ophthalmologist. 

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Exactly @conlt or any other "disease" of the eye.  However, not for routine vision care like helping you with glasses so you can read or see distances further.  They won't pay for it (Medicare).

[NicksmomESQ]

My DH & I both have Original Medicare & a supplement. A few months ago we both went to an Ophthalmologist to have our eyes checked. We paid a copay of $20 each.

 I needed new reading glasses. I went to Costco & got a pair of very stylish glasses with tint, anti glare,blue light blocking etc. for $128 complete.

[chickenbutt]

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@Desert Lily wrote:

I had an exam by an ophthalmologist in April, and I think I paid around $100 without insurance. When I bought glasses, Target had 40% the total for those without vision insurance, and I bought Ralph Lauren frames there. It actually cost me less to buy progressive & transition glasses there without insurance than it did when I had insurance and purchased glasses someplace else.

@wagirl  If you're anxious to get an exam before you look at changing Medicare programs, you could ask what the cost of the exam is and have more info for your decision.

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@Desert Lily , how is the quality of the frames and lenses at Target?   I need new glasses really badly but cannot afford it right now, plus I don't have any medical ins except for Medicare pt A.    I know I have to pay and my glasses aren't cheap.

But quality matters a lot to me because I have to wear the same ones for years.   I got them at Walmart once and the quality of the frames AND lenses was really bad so I never went back there.

Years ago my husband has a vision care policy and I would get mine at Lenscrafters for a fairly small amount and they were good.  But w/o coverage I could never afford them now.

Just looking for good choices for when I can make this happen.    TIA for any advice.