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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.
Medicare does not pay for low vision aids. This exclusion includes all devices that use one or more lenses to aid vision or magnify images. This rule applies no matter the size, form or technological features of the device. This rule does not apply to: 1. post-surgical prosthetic lenses after surgery in which the lens of the eye was removed; 2. prosthetic intraocular lenses (IOLs) and one pair of conventional eyeglasses or contact lenses furnished after each cataract surgery with insertion of an IOL; and 3. prosthetic lenses used by those who are lacking the natural lens of the eye and who were not furnished with an IOL. You can find this rule at 42 CFR Section 411.15(b). Medicare does not pay for eye exams for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses for refractive error only. Medicare does not pay for procedures performed in the course of any eye exam to determine the refractive state of the eyes. Refractive procedures are not covered even when done in connection with otherwise covered diagnosis or treatment of illness or injury. You can find these rules at 42 CFR Section 411.15(c). The rules say that scratch resistant coating (V2760), mirror coating (V2761), polarization (V2762), deluxe lens feature (V2702) and progressive lenses (V2781) will be denied as noncovered. Only standard frames (V2020) are covered. Additional charges for deluxe frames (V2025) will be denied as noncovered. You can find this information in Medicare's Local Coverage Article: Refractive Lenses - Policy Article (A52499).
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.
The Plan contract says that the Plan covers items and services in accordance with Medicare rules. The health plan contract says that Post-cataract: Your plan covers one pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens. (If you have two separate cataract operations, you cannot reserve the benefit after the first surgery and purchase two eyeglasses after the second surgery.) Our plan covers one refractive routine vision exam per calendar year. The purpose of this exam is to check your vision to determine if corrective eyewear or updated eyeglass or contact lens prescriptions are needed. A refraction is the part of an office visit that determines your eyeglass prescription. Both services are included under the Routine Vision Exam benefit. Routine vision hardware+: Your plan includes routine eyeglasses or contact lenses every calendar year. You have an allowance of up to $100 per calendar year for a combination of routine prescription contacts, routine prescription lenses, routine vision frames, and/or upgrades, such as tinting. This means we will pay up to $100 per calendar year for routine vision hardware. Routine prescription contact lens fitting services are included under the routine vision hardware benefit. Any amount billed by the provider above the allowance would be your responsibility. You are not limited to a network provider. You can get your routine vision hardware from any qualified provider. Your routine vision hardware allowance is the same for all providers. Please ask the provider to bill us for the services using the Claims address on the back of your member ID card. You may also request reimbursement from us. You can find this information in Chapter 4 on pages 105-106 of the plan's 2020 Evidence of Coverage.