Everything You Need to Know About Medicare and Scleral Lenses in 2025

Medicare generally does not cover routine vision care, including the cost of standard contact lenses or scleral lenses. However, there are specific medical situations where coverage may apply.

Understanding Medicare Coverage for Scleral Lenses

Scleral lenses differ from traditional contact lenses by resting on the sclera—the white part of the eye—instead of the cornea. These gas-permeable lenses are designed to improve vision for individuals with corneal irregularities caused by conditions such as keratoconus, scarring, or post-surgical changes.

While Medicare typically excludes coverage for vision correction devices, it may cover scleral lenses if prescribed for medical reasons. This includes cases where lenses are deemed necessary to treat eyes that have become sightless and have reduced in size due to inflammatory diseases, or to alleviate severe dry eye syndrome by acting as artificial tear substitutes.

In such cases, Medicare Part B may cover scleral lenses as prosthetic devices. Beneficiaries should be aware that coverage involves an annual deductible—$257 in 2025—and a 20% coinsurance on the costs.

It's essential to consult with your healthcare provider and Medicare plan representative to confirm your eligibility and understand any out-of-pocket expenses related to scleral lenses.

Cost Considerations for Scleral Lenses

The price of scleral lenses varies based on the type and fitting process. According to the American Academy of Ophthalmology, premium options like Prose lenses, which include custom fitting, can range from $5,000 to $7,000 per eye. More affordable alternatives typically cost between $1,000 and $5,000 per eye, including fitting fees.

When exploring scleral lens options, factor in both the lens and fitting costs to make an informed decision that suits your medical needs and budget.

Discover the latest news and current events in Sexual Wellness as of 01-08-2024. The article titled " Everything You Need to Know About Medicare and Scleral Lenses in 2025 " provides you with the most relevant and reliable information in the Sexual Wellness field. Each news piece is thoroughly analyzed to deliver valuable insights to our readers.

The information in " Everything You Need to Know About Medicare and Scleral Lenses in 2025 " helps you make better-informed decisions within the Sexual Wellness category. Our news articles are continuously updated and adhere to journalistic standards.