Do Medicare Plans from Humana Cover Routine Vision Care?

If you’re comparing Medicare Advantage plans and you wear contact lenses or prescription eyewear, you may want to find a plan option that includes routine vision care. You may be able to enroll in a Humana Medicare Advantage plan with routine vision care or add a Humana MyOptionSM vision plan to add routine vision benefits to your Humana Medicare Advantage plan.

When does Medicare cover vision care?

If you are enrolled in Original Medicare (Part A and Part B), you probably know that there is limited coverage available for vision care. Original Medicare only covers medically necessary treatment and procedures for maintaining eye health, such as cataract surgery. Or, for example, if you suffer a serious injury affecting the eye, Medicare may pay for medical treatment related to your injured eye.

However, coverage of routine eye care (like eye exams and prescription lenses) is offered in very specific circumstances. Though Medicare generally will not pay for eyeglasses or contact lenses, Medicare Part B (medical insurance) will help pay for one pair of eyeglasses or one set of contact lenses after you have had cataract surgery that implants an intraocular lens. Also, if you have diabetes, Medicare Part B covers a yearly eye exam for diabetic retinopathy by a qualified eye doctor. You may need to pay 20% of the Medicare-approved amount and the Part B deductible applies.

Do Humana’s Medicare Advantage plans cover routine vision care?

Some Humana Medicare Advantage plans include coverage for routine vision care like a routine exam. You may also be able to enroll in a Humana MyOptionSM vision plan to add on to your Humana Medicare Advantage plan.

Humana offers the following Medicare Advantage plans:

  • Humana Medicare Advantage Health Maintenance Organization (HMO) plans, which may require you to select a primary-care provider and get all of your care in network, except for medically-necessary emergency care.
  • Humana Medicare Advantage Preferred Provider Organizations (PPO)* plans, which let you see any doctor who accepts Medicare, but may offer significant cost savings if you use in-network providers.
  • Humana Medicare Advantage Private Fee-for-Service Plans (PFFS), which lets you see any doctor or facility that accepts Medicare and the terms of your plan.

Depending on the Medicare Advantage plan you choose from Humana, you may be able to add the optional supplemental benefits for routine vision care mentioned above. Humana MyOptionSM vision plan benefits include:

  • An annual allowance to use toward a routine annual eye exam. Benefits can be used with both in-network and out-of-network providers.
  • An annual allowance toward the purchase of one pair of prescription eyewear or contact lenses.

Humana MyOptionSM vision plan benefits can be added to your Humana Medicare Advantage plan at any time during the year, if they are available in your location and allowed with your plan. However, you can generally sign up for Medicare Advantage plans during certain time periods.

What should I know about Humana’s Medicare Advantage plans and routine vision care?

Humana is a private insurance company approved by Medicare to offer health benefits to its members; as such, not every plan type and benefit may be available in every area. In addition, plan premiums and benefits may vary depending on your plan service area.

You must continue to pay your Medicare Part B premium each month if you enroll in any Medicare Advantage plan, plus any additional premium your plan may require.

You may be required to use Humana network providers to access the full benefit for your routine vision care coverage.

Remember, you don’t lose any Medicare coverage when you enroll in a Medicare Advantage plan. By law, these plans must offer all the same benefits available under Original Medicare, except for hospice care, which Medicare Part A still provides. Medicare Advantage plans, such as those offered by Humana, are simply an alternative way to get your Original Medicare benefits with the convenience of one simple plan. But Medicare Advantage plans can offer extra coverage to plan members, such as routine vision and dental care, depending on the plan. Please note that premiums, copayments, and deductibles may apply; please contact the plan for more details.

If you’d like, we can help you find and choose a Medicare Advantage plan option that may work for you. Just contact one of eHealth’s licensed insurance agents at the number located at the top of this page.

*Out-of-network/non-contracted providers are under no obligation to treat Humana plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Humana is a Medicare Advantage HMO, PPO, and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any Humana Medicare plan depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or member cost-share] may change on January 1 of each year.

You must continue to pay your Medicare Part B premium.

The [Formulary, pharmacy network, and/or provider network] may change at any time. You will receive notice when necessary.

Humana’s pharmacy network offers limited access to pharmacies with preferred cost sharing in urban areas of < AL, CA, CT, DC, DE, IA, IL, IN, KY, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NH, NJ, NY, OH, OR, PA, RI, SC, SD, TN, VA, VT, WA, WI, WV; suburban areas of AZ, CA, CT, DE, HI, IL, MA, MD, ME, MI, MN, MO, MT, ND, NH, NJ, NY, OH, OR, PA, PR, RI, VT, WA, WV >; and rural areas of < AK, IA, MN, MT, ND, NE, SD, VT, WY > . There are an extremely limited number of preferred cost share pharmacies in urban areas in the following states: < DE, MA, MD, ME, MI, MN, MS, ND, NY, OH, SC, and VT> ; suburban areas of: < MT and ND > ; and rural areas of: < ND >. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, please call Customer Care at <1-800-281-6918 (TTY: 711)> or consult the online pharmacy directory at Humana.com.

Humana MyOption optional supplemental benefits (OSB) are only available to members of certain Humana Medicare Advantage (MA) plans. Members of Humana plans that offer OSBs may enroll in OSBs throughout the year. Benefits may change on January 1st each year.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

Last Updated Date: 7/30/2017


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