Aetna Medicare's Vision Coverage Basics

Aetna Medicare plans do not cover eyeglasses or contact lenses under Original Medicare Part B. However, some Aetna Medicare Advantage plans (Part C) include vision benefits that pay toward frames, lenses, and eye exams. What you pay depends on which Aetna plan you have, because vision coverage is optional and varies plan to plan.

If your Aetna Medicare Advantage plan includes vision, you typically get coverage for one eye exam per year and an allowance toward frames and lenses — often $100 to $200 per year, though some plans offer more. You will pay a copay at the eye doctor's office, usually $10 to $50 for an exam. For glasses, you either pay the copay and the plan covers the rest up to its limit, or you pay the difference if you choose a more expensive frame.

The catch: you must use an in-network eye doctor or optometrist. If you go out of network, Aetna will not pay, and you will owe the full cost. Your plan documents or Aetna's website will list which providers are in your network in your area.

Key Takeaways

  • Original Medicare does not cover eyeglasses, but some Aetna Medicare Advantage plans do, with coverage amounts ranging from $100 to $200 per year depending on the plan.
  • You must see an in-network eye doctor or optometrist; out-of-network visits are not covered and you pay the full bill yourself.
  • Most plans cover one eye exam per year with a copay of $10 to $50, plus a separate allowance for frames and lenses.
  • Your actual out-of-pocket cost depends on your specific Aetna plan, so you need to check your plan documents or call Aetna to know your coverage limits.
  • If your current Aetna plan does not include vision, you can switch to a plan that does during the annual open enrollment period (October 15 to December 7).

How to Find Out What Your Aetna Plan Covers

The fastest way is to call the member services number on the back of your Aetna Medicare card. Have your member ID ready. Ask whether your plan includes vision coverage, what the annual allowance is, what the copay is for an eye exam, and whether you need a referral to see an optometrist or eye doctor.

You can also log into your Aetna account online and look for the "Benefits" or "Coverage" section. Most plans post a summary of benefits document that lists vision coverage line by line. If you cannot find it online, call and ask Aetna to email or mail you the summary.

Write down the answers — the allowance amount, the copay, and whether referrals are required — before you schedule an eye appointment. This prevents surprises at the checkout desk.

In-Network vs. Out-of-Network Eye Doctors

Aetna maintains a network of eye doctors and optometrists in every state. If you see someone in that network, your copay and the plan's allowance explore. If you see someone outside the network, Aetna pays nothing, and you pay the entire bill yourself — typically $150 to $300 for an exam and $200 to $400 for frames and lenses, depending on where you live and what you choose.

To find in-network providers, go to Aetna's website, click "Find Care and Costs," and search for "optometrist" or "ophthalmologist" in your zip code. The list will show which doctors are in your plan's network. You can also call Aetna member services and ask them to give you three or four names near your home.

Some people choose out-of-network doctors for a specific reason — a doctor they have seen for years, or one with a particular specialty. If that is your situation, ask Aetna whether they offer any out-of-network reimbursement. A few plans do, though it is usually a flat amount like $50, and you still pay the rest.

What Happens If Your Plan Does Not Include Vision

If your current Aetna Medicare Advantage plan has no vision benefit, you have two options: switch to a different Aetna plan that does include vision, or buy a standalone vision plan.

To switch Aetna plans, you must wait for the annual open enrollment period, which runs from October 15 to December 7 each year. During this window, you can change to any other Aetna Medicare Advantage plan offered in your area. Plans with vision benefits are usually labeled clearly in Aetna's plan comparison tool. You can also call Aetna and ask which of their plans in your area include vision coverage.

Standalone vision plans are sold by companies like VSP, EyeMed, and Humana, and cost $10 to $25 per month. They cover eye exams, glasses, and contacts at a wider network of providers than Medicare Advantage plans do. If you like your current Aetna plan but want vision coverage, a standalone plan may be cheaper than switching.

Copays and Out-of-Pocket Costs

If your Aetna plan includes vision, here is what you typically pay at the eye doctor's office. The copay for an eye exam is usually $10 to $50. The copay for frames is often $0 to $25. The copay for lenses depends on the type — single vision lenses might be $0 to $25, while bifocals or progressive lenses might be $50 to $100.

After you pay your copay, Aetna pays the rest up to your annual allowance. If you choose frames that cost more than your allowance, you pay the difference. For example, if your allowance is $150 and you pick frames that cost $250, you pay $100 plus your copay.

Some Aetna plans also cover contact lenses instead of glasses, usually with the same annual allowance. Ask your eye doctor whether they can bill for contacts, and whether the copay is the same.

Frequency of Coverage and Renewal

Most Aetna Medicare plans cover one eye exam per calendar year. This means if you had an exam in March, you cannot have another covered exam until January of the next year. Some plans cover exams every two years instead, so check your plan documents.

For glasses, the annual allowance resets on January 1 each year. If you use your $150 allowance in February, you will not get another $150 until January. A few plans allow you to carry over unused allowance to the next year, but this is uncommon — ask Aetna whether yours does.

If you need glasses more than once a year for medical reasons — for example, if your prescription changes significantly — talk to your eye doctor about whether they can document medical necessity. Some plans will cover a second pair in that situation, though you will need to submit the request to Aetna in writing.

How to Use Your Vision Benefit When You Buy Glasses

Call an in-network eye doctor or optometrist and schedule an exam. Tell them you have an Aetna Medicare plan and ask whether they accept it. Most do, but it is worth confirming.

At your appointment, bring your Aetna Medicare card. The doctor will do your eye exam and write a prescription. If the exam is covered, you will pay your copay only. Then you choose frames. The eye doctor's office will tell you what your copay is for frames and lenses, and what Aetna will pay. If the frames cost more than your allowance, you pay the difference on the spot or they bill you later.

The glasses usually take one to two weeks to arrive. When they do, you pick them up and pay any remaining balance. Keep your receipt and the paperwork showing what Aetna paid — you may need it for your records or if there is a billing problem.

Frequently Asked Questions

Does Aetna Medicare cover the cost of an eye exam?

If your Aetna Medicare Advantage plan includes vision benefits, yes — you pay a copay of $10 to $50 and Aetna covers the rest. Original Medicare does not cover eye exams. Check your plan documents or call Aetna to confirm your plan includes vision.

What if I need new glasses but my annual allowance is used up?

You pay the full cost yourself. Some plans allow you to request an exception if your prescription changed significantly for medical reasons, but this is not may provide. Your best option is to contact Aetna and ask whether they will make an exception in your case.

Can I use my Aetna vision benefit at any eye doctor?

No, only at in-network providers. If you go out of network, Aetna will not pay anything. Use Aetna's provider search tool on their website or call member services to find doctors near you who are in your plan's network.

Does Aetna Medicare cover contact lenses?

Some plans do, using the same annual allowance as glasses. Ask your eye doctor whether they can bill for contacts, and whether your specific Aetna plan covers them. Not all plans offer this option.

Can I switch to an Aetna plan with vision coverage if mine does not have it?

Yes, but only during the annual open enrollment period from October 15 to December 7. You can switch to any other Aetna Medicare Advantage plan offered in your area. Call Aetna or visit their website to see which plans include vision benefits.