Will Medicare pay for glasses for my wife post eye surgery?

Jpapapia asked...

Will Medicare pay for glasses for my wife post eye surgery? I am trying to just get advice from someone. Last year, my wife has surgery on both eyes and was told that since she had that done Medicare would pay for her new glasses. However, now we are paying for them. We had the surgery done by Lens Crafters in Peoria, IL. The glasses were $1100.00 dollars and we are being billed by a company called GE Money Bank of Orlando, Florida. She is on oxygen 24/7 and has bad lungs.We can't keep paying for this and don't want to be sued. Please help us.

Expert Answer

Depending on the kind of eye surgery your wife had, Medicare Part B may be able to pay for some of the cost of her glasses. Medicare Part B can pay for one pair of eyeglasses if your wife had cataract surgery in which a new lens was implanted in her eye. If she had a different kind of surgery, Medicare does not pay for glasses.

If Medicare covers glasses for your wife, it will pay for both the lenses and frames, but only basic frames. If she bought more expensive frames, she has to pay out of pocket for the difference between the standard amount Medicare pays and the amount her frames actually cost. She also has to pay a coinsurance amount, which is 20 percent of the amount Medicare approves for the lenses and frames. In order to get Medicare to pay its share for your wife's glasses, she has to give her Medicare information to the company that sold her the glasses, and the company is then supposed to file a Medicare Part B claim for her. Even if they filed the claim, though, Medicare might not have approved it, or only approved it for a small amount, leaving your wife to pay the rest of the bill.

To get help with a Medicare claim to pay for the glasses, your wife can contact the non-profit Health Insurance Counseling and Advocacy (HICAP) program in Illinois at 800-548-9034. They'll put her in touch with the local HICAP office nearest you, where you can make an appointment to speak, for free, to one of their counselors who's experienced with Medicare claims.