Do Anthem Medicare Plans Cover Routine Vision Services?

Last Updated : 09/09/20184 min read

If you’re shopping for Medicare vision coverage, you may be interested in Anthem Medicare Advantage or Anthem Extras plans to help you manage your out-of-pocket costs for routine vision care. Learn more about Anthem Medicare vision coverage and the Anthem Medicare Advantage and Anthem Medicare Supplement plans that may be available in your area.

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What Medicare vision coverage is available with Anthem Medicare Advantage plans?

Anthem is a private company contracted with Medicare to provide an alternative way for enrollees to access their Part A and Part B benefits under Original Medicare. All Anthem Medicare Advantage plans are required to provide at least the same coverage as Original Medicare (except for hospice care, which is still covered by Part A), but they are also authorized to offer additional benefits to help Medicare beneficiaries lower their out-of-pocket costs. While there are no benefits for routine vision care under Original Medicare, you may be able to get vision coverage through an Anthem Medicare Advantage plan.

Anthem has several different Medicare Advantage plans that may be available, depending on where you live. Here are a few of the kinds of Medicare Advantage plans Anthem offers in some locations:

  • Anthem MedicareAdvantage Health Maintenance Organization (HMO) – HMOs typically require you to receive care within the plan’s provider network, choose a primary care physician, and get a referral when you need a specialist in most cases.
  • Anthem MedicareAdvantage Preferred Provider Organization (PPO)* – PPOs generally let you go to out-of-network doctors, but you might have higher out-of-pocket costs if you do. You don’t generally need to choose a primary care physician or get a referral to see a specialist.
  • Anthem MedicareAdvantage Special Needs Plans (SNPs). Please note that enrollment in these types of plans is limited to individuals with certain diseases or chronic conditions; plan benefits, provider networks, and formularies are designed to meet the health-care needs of these patients. SNPs always include prescription drug coverage.
  • Depending on where you live and the Anthem Medicare Advantage plan you select, you may be eligible to get Medicare vision coverage through an Optional Supplemental Benefits plan. Anthem’s Optional Supplemental Benefits options may include:
  • A preventive dental package
  • A routine dental and vision package
  • An enhanced dental and vision package

These plans have varying copayments, coinsurance amounts, and annual benefit caps, and may require you to use Anthem’s network of providers. You must continue to pay your Part B premiums with any Medicare Advantage plan, and you may have an additional premium, depending on the plan you select. Not all plans are available in all locations, and plan benefits and premiums may vary from place to place. 

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Do Anthem Medicare Supplement plans include vision coverage?

Medicare Supplement plans, also called Medigap, are designed to help pay for your Original Medicare out-of-pocket expenses (such as coinsurance, copayments, and deductibles). Medigap plans don’t include routine vision coverage. You may be able to add Medicare vision coverage by enrolling in an Anthem Extras package.

Anthem Extras plans are separate from Medigap plans. You can sign up for an Anthem Extras package even if you don’t have an Anthem Medicare Supplement plan.

Anthem Extras Packages offer various benefits, which may include:

  • Preventive and/or comprehensive dental care
  • Routine vision exams and prescription eyewear, including contact lenses
  • Travel assistance
  • Older adult care
  • SilverSneakers wellness program

Not all Anthem Medicare Supplement plans are available in all areas, and the same is true of Anthem Extras packages. Plan premiums may vary.

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*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) 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.

Anthem Blue Cross and Blue Shield serves Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.

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