When you become eligible for Medicare, one of the biggest decisions you'll face is whether to enroll in Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C). For eye care patients in particular, this choice can significantly affect what services are covered and what you'll pay out of pocket.
Original Medicare (Parts A & B)
Original Medicare is the federal program administered directly by the government. Part A covers hospital care; Part B covers outpatient and physician services. For eye care, Part B covers medically necessary services — such as treatment for glaucoma, diabetic eye disease, and cataract surgery — but does not cover routine exams or glasses.
Medicare Advantage (Part C)
Medicare Advantage plans are offered by private insurers approved by Medicare. They must cover everything Original Medicare covers, but many add extra benefits — including routine vision exams, an eyewear allowance, and sometimes even discounts on LASIK or cosmetic eye treatments.
The trade-off: Advantage plans typically use provider networks, which means your ophthalmologist must be in-network for you to receive the plan's full benefit. Always verify that Fox Valley Ophthalmology is listed in-network before enrolling.
Side-by-Side Comparison
| Feature | Original Medicare | Medicare Advantage |
| Medically necessary eye care | ✓ Covered | ✓ Covered |
| Routine eye exams | Not covered | Often included |
| Eyeglasses / contacts | Post-cataract only | Often included (allowance) |
| Network restrictions | No — see any Medicare provider | Yes — in-network required |
| Referral required | No | Sometimes |
| Monthly premium | Part B premium (~$185/mo in 2026) | Varies; sometimes $0 extra |
Before switching plans: Check whether your current ophthalmologist, any ongoing treatments, and any prescriptions are all covered under the new plan. Changes during open enrollment take effect January 1st — plan ahead to avoid gaps in care.
Questions? Ask Before Open Enrollment Ends
Our office is happy to help you understand how your coverage applies to your specific eye care needs. Call us or ask at your next appointment, and we can review your current plan with you.
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