Visionworks and Medicare: The Short Answer
Visionworks does not accept Original Medicare (Part A and Part B) for routine eye exams, glasses, or contact lenses. Original Medicare does not cover routine vision care at all — it only pays for certain eye conditions like diabetic retinopathy or age-related macular degeneration when treated by an ophthalmologist.
However, if you have a Medicare Advantage plan (Part C), some plans include vision benefits that Visionworks may accept. Whether your specific plan works with Visionworks depends on your insurance carrier and the plan you chose. You will need to check your plan documents or call your plan's customer service line to confirm.
If you have a standalone vision insurance plan through a former employer or purchased separately, Visionworks may accept that as well. Again, acceptance varies by plan.
Key Takeaways
- Original Medicare does not cover routine eye exams, glasses, or contacts, so Visionworks cannot bill Medicare directly for these services.
- Some Medicare Advantage plans include vision coverage that Visionworks may accept, but you must verify with your specific plan first.
- The only way to know if your plan works at Visionworks is to call your plan's customer service number and ask which eye care providers are in-network.
- If Visionworks is out-of-network for your plan, you can still receive care there but will likely pay more out of pocket.
- Standalone vision plans from employers or private insurers may also be accepted at Visionworks, depending on the plan.
How to Check If Your Plan Works at Visionworks
The fastest way is to call your Medicare Advantage plan's customer service number. This number is on your insurance card. Tell them you want to know if Visionworks is an in-network provider for vision care.
They will tell you one of three things: Visionworks is in-network (your plan covers exams and frames there), Visionworks is out-of-network (you can go but will pay more), or your plan does not include vision coverage at all. Write down what they tell you and ask them to note it in your file.
If you have a standalone vision plan in addition to Medicare, call that insurer's customer service line separately. Vision plans often have their own provider networks that differ from medical insurance networks.
What Original Medicare Covers for Vision Care
Original Medicare covers only specific eye conditions, not routine care. It will pay for an eye exam and treatment if you have diabetic retinopathy, age-related macular degeneration, glaucoma, or cataracts — but only when an ophthalmologist (a medical doctor who specializes in eye care) provides the diagnosis and treatment.
Original Medicare does not cover eyeglasses, contact lenses, or routine eye exams for refraction (checking your prescription). It also does not cover routine eye care from an optometrist unless that optometrist is billing for a specific medical condition covered by Medicare.
If you need glasses or contacts, you will pay for them out of pocket unless you have a separate vision plan or a Medicare Advantage plan that includes vision benefits.
What Medicare Advantage Vision Benefits Usually Cover
Medicare Advantage plans vary widely. Some include no vision coverage at all. Others cover an annual eye exam, a set dollar amount toward frames, and a set dollar amount toward contacts or lenses. A few cover more generous benefits.
Common coverage includes one routine eye exam per year and a benefit of $100 to $200 per year toward frames and lenses combined. Some plans cover contacts instead of glasses, or offer a choice. A small number of plans cover both an exam and frames at no cost to you.
The only way to know what your plan covers is to read your plan's Summary of Benefits and Coverage (which your plan mailed to you) or call customer service. Do not assume two Medicare Advantage plans from the same insurance company offer the same vision benefits — they often do not.
If Visionworks Is Out-of-Network for Your Plan
You can still go to Visionworks even if they are not in-network for your Medicare Advantage plan. You will straightforward pay more. Out-of-network providers can charge higher fees, and your plan may reimburse you at a lower rate or not at all, depending on your plan's rules.
Before you go, ask Visionworks for an estimate of what they will charge for an exam and frames. Then call your plan and ask what they will reimburse for out-of-network vision care. This way you will know your out-of-pocket cost before you sit down in the chair.
If the cost is too high, ask your plan which eye care providers are in-network. You may find another provider closer to you or with better hours.
Paying Out of Pocket at Visionworks
If you have no vision coverage through Medicare or a separate plan, you will pay Visionworks directly. Visionworks typically charges between $100 and $200 for a comprehensive eye exam, depending on location and what tests are included. Frames usually range from $100 to $400, and lenses add another $100 to $300 depending on your prescription and lens type.
Ask Visionworks about discounts for seniors or cash-pay customers. Some locations offer reduced rates if you pay in full at the time of service. You can also ask whether they offer a payment plan if the cost is a burden.
If cost is a concern, look into whether your state or local area offers low-cost vision clinics or charitable eye care programs. Some communities have vision centers that serve uninsured or low-income seniors at reduced rates.
What to Bring When You Visit Visionworks
Bring your insurance card — whether it is a Medicare Advantage card, a vision plan card, or both. Bring a photo ID and your Social Security number. If you have had an eye exam elsewhere in the past year, bring those records if you have them, though Visionworks can usually request them.
If you are paying out of pocket, ask in advance whether Visionworks accepts cash, card, or both. Some locations have payment plans through third-party lenders like CareCredit, though these charge interest if you do not pay in full within a promotional period.
Frequently Asked Questions
Can I use my Original Medicare to pay for glasses at Visionworks?
No. Original Medicare does not cover glasses, contacts, or routine eye exams. It only covers treatment for specific eye diseases like cataracts or diabetic retinopathy when an ophthalmologist provides the care. If you need glasses, you will pay out of pocket or use a separate vision plan.
How do I know if my Medicare Advantage plan covers vision at Visionworks?
Call your Medicare Advantage plan's customer service number (on your insurance card) and ask if Visionworks is in-network for vision care. They can tell you in one call. You can also check your plan's provider directory online if your plan has one.
What if my plan covers vision but Visionworks is out-of-network?
You can still go to Visionworks, but you will likely pay more out of pocket. Ask Visionworks for a cost estimate and call your plan to ask what they will reimburse for out-of-network care. Then you will know your total cost before your appointment.
Does Visionworks accept Medicaid?
Visionworks' acceptance of Medicaid varies by state and location. Some Visionworks stores accept Medicaid vision benefits, and others do not. Call your local Visionworks store or your state Medicaid program to confirm whether your state's Medicaid covers vision care and which providers accept it.
Can I get a refund if I buy glasses and then find out my insurance does not cover them?
Visionworks' return policy typically allows returns within 30 days if frames are unworn and in original condition. However, once you have worn glasses, most retailers do not accept returns. Ask about the return policy before you pay, and keep your receipt.