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Decision: unknown

 
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). 
 
For beneficiaries with pseudophakia, coverage is limited to one pair of eyeglasses or contact lenses after each 
cataract surgery with insertion of an IOL. Replacement frames, eyeglass lenses and contact lenses are 
noncovered. If a beneficiary has a cataract extraction with IOL insertion in one eye, subsequently has a cataract 
extraction with IOL insertion in the other eye and does not receive eyeglasses or contact lenses between the 
two surgical procedures, Medicare covers only one pair of eyeglasses or contact lenses after the second 
surgery. If a beneficiary has a pair of eyeglasses, has a cataract extraction with IOL insertion, and receives only 
new lenses but not new frames after the surgery, the benefit will not cover new frames at a later date (unless it 
follows subsequent cataract extraction in the other eye). 
 Only standard frames (V2020) are covered. Additional charges for deluxe frames (V2025) will be denied as 
noncovered. You can find this information in the Centers for Medicare and Medicaid Services (CMS) Policy 
Article  Refractive Lenses (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 Plan's 
contract states that one pair of eyeglasses or contact lenses may be covered after each cataract surgery that 
includes insertion of an intraocular lens. Covered eyeglasses after cataract surgery includes standard frames and 
lenses as defined by Medicare; any upgrades are not covered (including, but not limited to, deluxe frames, 
tinting, progressive lenses or anti-reflective coating). You can find this information on page 88 of the Plan's 
2021 Evidence of Coverage.