Medicare: Post-cataract coverage for glasses/lenses, anyone try this?

[Telly]

I always assumed that Original Medicare (Part B) did not pay for any sort of vision care, other than medical-related. By chance, I overheard something about post-cataract surgery coverage, so googled. I found they DO COVER glasses/lenses required after cataract surgery, but a lot of limitations and hoops.

https://www.medicare.gov/coverage/eyeglasses-contact-lenses

Medicare doesn’t usually cover eyeglasses or contact lenses.
However, Medicare Part B (Medical Insurance) helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens. Corrective lenses include one pair of eyeglasses with standard frames or one set of contact lenses.

Your costs in Original Medicare

You pay 100% for non-covered services, including most eyeglasses or contact lenses.
You pay 20% of the Medicare-approved amount for corrective lenses after each cataract surgery with an intraocular lens, and the Part B Deductible applies. You pay any additional costs for upgraded frames. Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter if you or your supplier submits the claim

From the American Optometric Association, I found this (could not link it):

Fees for DME suppliers

All suppliers of Durable Medical Equipment, Orthotics and Prosthetics (DMEPOS), including eyeglasses and contact lenses for postoperative cataract patients, are subject to an enrollment and revalidation fee. The AOA continues to advocate with the Centers for Medicare & Medicaid Services so that doctors who are enrolled in Medicare as physicians should be exempt from this fee.

From an optical shop website:
http://www.atlantaeyephysicians.com...for Eyeglasses Following Cataract Surgery.pdf

Our optical shop accepts assignment from Medicare on the purchase of frames and lenses after cataract surgery
and can assist in the selection, cost, and filing a claim with Medicare. We will determine how much Medicare will pay toward your frames and lenses and we will not collect Medicare’s payment from you. We will only collect your portion of the cost (co-insurance) at the time of service.

Frame–Medicare pays a fixed amount toward the frame and you pay the balance. If you select a basic frame your out of pocket expense may only be the co-insurance (typically the 20% that Medicare does not pay of the approved amount). If your frame selection cost is greater than basic frame cost, your out of pocket expense would be the 20% co-insurance and the additional cost above a basic frame.
We carry a large selection of basic frames priced within Medicare’s fee schedule.

Lenses–Medicare pays various amounts for each type of lens (single vision, bi-focal, and tri-focal). Your out-of-pocket expense (co-insurance) will vary depending on the lens selected.Medicare does not pay for upgrades, such as progressive or transition lenses.The additional cost for these upgrades would be an out-of-pocket expense for you.

This statement from Medicare is a real limiting factor:

Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter if you or your supplier submits the claim.

So it seems the hurdles for me are:
- Finding an enrolled supplier (and wanting to work with them!).
- Progressive lenses are NOT covered, pay adder. (I need this).
- Transition (darkening) lenses are NOT covered, pay adder. (I need this).

Has anyone been able to make a go of this concept of Medicare sharing the cost? Wondering if it is more hassle and searching than it's worth. The optical shop I have been using does not handle Medicare. The place I overheard the comment that started all this, does NOT handle any insurance Medicare or otherwise.

Comments?

 

[nwsteve]

We tried this with Costco who is not an enrolled provider. They did provide all the forms for submitting directly to Medicare the expenses. Charges were never reimbursed by Medicare. DW called Medicare and confirmed they had the charges but they never indicated to her when they were going to pay. It is quite possible they went to our deductible but we never got an EOB either or was it sent to our Medigap provider. Ultimately, we decide it was not worth the time and frustration and added to our medical deduction for the year. Her Optometrist was enrolled with Medicare but glasses from his inhouse optical biz were several times the Costco price and Medicare payment was limited, so net net Costco was still less expensive

 

[W2R]

I have no idea! All I have needed since my cataract surgery is cheap readers which cost nearly nothing. I don't need glasses any more.

It's been great to finally be free of glasses, after wearing them my whole adult life at every waking moment.