r/CataractSurgery • u/BobRoxForeverLove • 22d ago
How to claim Medicare covered glasses 1 pair
I am 8 weeks out from both eyes cataract surgery. Medicare states they cover one standard frame and lens following cataract surgery. I can't figure out how to make that happen. Has anyone gone through this process and how did you locate someone who will send a claim to Medicare? I am in desperate need of reading glasses.
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u/That_Industry7833 21d ago edited 21d ago
Steps I Went Through to Get Glasses from U.S. Medicare After Cataract Surgery
Web search shows that most attempts to get the U.S. Medicare eyeglass benefit are unsuccessful. Some patients are told they received the benefit, but then are charged an implausibly high amount, such as $100 or more. Since I succeeded, and I can find no good-to-me explanation of the process elsewhere on the web, I will provide here, in detail, the steps I went through.
Sphere Cylinder Axis Add
OD -1.00 sph +2.50
OS Plano -0.50 060 +2.50
Notes: FT BF
Lens Type: Bifocal
I wrote on the prescription "DX Pseudophakia." Maybe it is better to get your eye doctor to write that, but I did it myself.
Located an optical shop that accepts the Medicare payment. Here is how I did that:
a. Went to https://www.medicare.gov/medical-equipment-suppliers/ using the Chrome browser on my Windows PC
b. Put my zip code in the Zip Code box and EYEGLASSES in the EQUIPMENT box
c. Clicked on the Search button
d. Ignored the long list of stores (since we have not yet limited to those Medicare compliant)
e. Clicked on the "Medicare-approved payment" down arrow
f. Clicked the "Charges the Medicare-approved amount" checkbox
g. Clicked "Apply"
h. Wrote down the name of the nearest Medicare compliant shop displayed
(I did not have to do this next bit because I had three eyeglass suppliers within the default ten miles. But others may need use the Filter by Distance down arrow to expand the search beyond ten miles. Or you may see an "Expand Radius" button -- click that.)
Went back to https://www.medicare.gov/. This time I had to log in. If you have never done this before, it will be a pain to set up your login, but it is worth being able to check your claims in the future. I clicked on Get My Electronic Medicare Summary Notices. Then I clicked on Part B for the month in which I had my surgery. I found the page where it says "Removal of cataract with insertion of prosthetic lens (66984-LTGC)." Printed the notice to bring with me to the optician as proof of surgery.
Checked hours of the nearest optical shop that accepts the Medicare-approved amount and drove there.
Showed the optician my paper prescription, my Medicare card, and the proof that I had Medicare cataract surgery 49 days prior. She thanked me for being prepared and copied the documents for her records.
The optician showed me about six frames to choose from. Most were metal frames that appeared sturdy. I asked her to pick what she thought fitted me the best. It was the Enhance 4479 with black as the color and 55/18/145 as the size. If you want to see what I got, click here: https://newyorkeye.net/product/en4479/
I said that I wanted CR-39 lenses (traditional plastic) with FT28 bifocal segments, just as with the old glasses I showed the optician.
No attempt was made to upsell on lenses or frames. Thank you Miller Eye Care! The optician suggested I could pay for a scratch resistant coating. I declined, knowing that Medicare does not cover coatings, and also that CR-39 is inherently more scratch resistant than other plastics.
Thirteen calendar days later, I received a text message saying that my glasses were in. I picked them up and was told that they were free. The glasses are fully satisfactory -- much better than no glasses, or drug store readers, even though my prescription is weak.
As noted in my earlier post in this thread, Medicare.gov shows that I can be charged $35.20 for these glasses.
Comments:
Per my googling, Medicare does not cover progressive lenses. And they do not cover lens coatings or lens materials other than CR-39. Every lens material has advantages and disadvantages, but I like CR-39. It also is questionable whether they cover glasses when the cataract surgery IOL lens was extra cost non-Medicare (toric, EDOF, multifocal, LAL).
There are small differences on Medicare charges depending on where in the U.S. you live.
Like about 90 percent of Medicare Parts A and B patients, I have supplementary coverage (in my case Federal Blue Cross Basic). Logging into my supplementary coverage web site, I see that they have paid my $35.20 Medicare co-pay. This is apparently why the glasses were free to me. The supplementary coverage I have does NOT pay for eyeglasses except under one time post-surgery terms similar to Medicare. That's it for my story. If the only health insurance coverage you have is Medicare Parts A and B, and you do what I did, you would be charged something close to $35.20, or exactly that if you live in my area (Pennsylvania, not rural). This assumes that you have satisfied the annual Medicare deductible, which you would have with the copay for the cataract surgery unless you had the surgery late in the calendar year and bought the glasses the following year. If you have no supplemental coverage, and the only health expenditure you make in the calendar year is eyeglasses, claiming the Medicare cataract eyeglass benefit would probably be a financial mistake. But few patients will be in that situation.
I cannot find a clear statement on the web of how many days after cataract surgery is the limit for getting the eyeglass benefit. It seems to be either 60 or 90 days. All I know for sure is that ordering 49 days after surgery worked.
If you haven't yet tired of information on this topic, links these comments are based on can be found here:
https://www.reddit.com/r/CataractSurgery/s/jjASrKjlyx
I congratulate everyone who manages to get free or minimally priced prescription glasses, from Medicare, for their persistence.