EyeMed Aetna Medicare Vision
Understanding your EyeMed Aetna Medicare vision coverage is essential for maintaining your eye health without surprises.
This guide provides you with the fundamental details of what’s included in your plan, the network of providers at your disposal, and the extra savings you’re entitled to, all without the usual confusion that insurance details can bring.
Key Takeaways
- Aetna offers vision insurance through EyeMed, providing members with an extensive provider network and benefits like annual vision exams and allowances for eyewear, but not all services are covered, and members should review plan details for exclusions and limitations.
- In addition to vision coverage, Aetna Medicare in 2025 includes dental and hearing benefits with certain preventive services covered at 100%, options for direct billing and reimbursements, and hearing aid coverage with savings and an allowance for advanced aids.
- Aetna’s vision plan offers digital tools such as the ‘Know before you go’ cost estimation tool and the Aetna Vision Preferred website and app, facilitating benefit management and access to special offers, while responding to COVID-19 by enhancing certain claims administration services and providing related information and resources.
Compare Plans in One Step!
Enter Zip Code
EyeMed Aetna Medicare: Enhancing Your Vision Care
Aetna Life Insurance Company and EyeMed have partnered to offer vision insurance plans for Aetna members, with a focus on quality eye care. However, please be aware that these plans do not cover all vision services.
Members are encouraged to thoroughly review their plan documentation for a full understanding of the benefits, exclusions, and coverage limitations.
The affiliation between EyeMed and the life insurance company Aetna is a professional one, with EyeMed offering specific network administration services for Aetna Vision.
EyeMed’s network of providers is extensive, comprising 78,000 establishments managed by EyeMed Vision Care. These providers offer a diverse range of services, including eye examinations, eyewear, and even online purchasing options for glasses and contact lenses.
Some providers in the EyeMed network include Glasses.com, ContactsDirect.com, LensCrafters, Ray-Ban, and Target Optical, all offering prescription sunglasses as well.
EyeMed’s network of providers
EyeMed maintains the quality of its network providers using a comprehensive program that:
- Monitors satisfaction
- Monitors clinical performance
- Verifies educational qualifications
- Verifies care quality
- Verifies licensing regulations compliance
Members have the flexibility to switch providers, including independent contractors, within the network for vision correction services, offering them a variety of options for their eye care needs. This provider’s participation ensures a diverse range of choices for members.
Aetna Medicare vision coverage
Aetna Medicare vision coverage includes:
- One annual routine vision exam every calendar year if the standard option plan is chosen
- An annual allowance for purchasing prescription eyewear
- Reimbursement options through either a network benefit or a direct member reimbursement (DMR) benefit
This ensures that your eyes receive the best care possible.
However, keep in mind that not all vision services are covered. Members should refer to the plan documents for a complete description of benefits, exclusions, limitations, and conditions where claims administration services are provided.
To better understand the coverage, it’s essential to review the plan features.
Dental and Hearing Benefits with Aetna Medicare
With Aetna Medicare, your oral health and hearing are also well-catered for. Aetna Medicare covers preventive dental care such as oral exams, cleanings, and X-rays, as well as comprehensive services like fillings and extractions.
Preventive services are covered at 100 percent on most Aetna Medicare plans, and Aetna Medicare Advantage plans also provide coverage for dental care. However, there are limitations on the amount of preventive care visits, and some services or supplies may not be covered.
Dental coverage options
When members use network dental providers, they do not need to handle reimbursement forms as the network providers will directly bill Aetna, ensuring a smooth reimbursement process.
If the provider is outside the Aetna Dental PPO Network, members are required to make upfront payments and submit a reimbursement request.
This helps maintain good oral health, especially during times of contagious respiratory illness caused by viruses or bacteria
. To submit a reimbursement request, members can complete and print the reimbursement form, or submit it online via their member account, ensuring that a receipt is included with the form.
Hearing aid coverage
Aetna Medicare offers hearing aid coverage through NationsHearing, which includes the following benefits:
- Savings on hearing aids
- Coverage for one annual routine hearing exam and hearing aid fitting at 100%
- Access to participating providers
- A hearing test at no additional cost
- A benefit allowance for advanced hearing aids
The annual routine hearing exam coverage includes one exam and a hearing aid fitting, both covered at 100%. Additionally, many plans offer coverage for the cost of hearing aids.
This can help individuals with hearing loss access necessary assistive devices. However, it’s important to note that there are limitations to the coverage for hearing aids under Aetna Medicare plans.
The Importance of Routine Eye Exams
Routine eye exams contribute not only to vision correction, but also to your overall health. By aiding in the early identification of potential medical issues before they become significant health concerns, regular eye examinations play a vital role in maintaining overall health.
These exams can identify abnormal changes in vision at an early stage, enabling timely and potentially more effective treatment.
Adults are advised to undergo routine eye exams every one to two years, with those between the ages of 18 to 64 potentially requiring annual examinations.
Detecting diabetes-related issues
Diabetes can lead to various eye problems, which can be detected early through regular eye examinations. Regular eye examinations can help in the early detection and prevention of blindness due to diabetes-related eye problems.
Typical diabetes-related eye issues detected include diabetic retinopathy and diabetic macular edema. It is recommended that diabetics undergo a comprehensive eye exam annually to prevent vision problems.
Identifying high blood pressure
High blood pressure can also be detected through regular eye exams. Ophthalmologists can detect early indications of high blood pressure by examining the blood vessels in the retina.
The retina is examined by conducting a fundoscopic or ophthalmoscopic examination, which helps in spotting early indications of high blood pressure such as hemorrhaging in the eyes.
Exclusive Savings for Aetna Members
Exclusive savings on eyewear and contact lenses are available to Aetna members. Aetna members can benefit from:
- Up to $150 instant savings on an annual supply of contact lenses from Target Optical
- 25% off contact lenses at CVS.com/Optical
- Price reductions on eyeglasses range from $20 to $50 at Glasses.com.
Furthermore, Aetna members are eligible for a 40% discount on additional pairs of glasses purchased at LensCrafters.
Discounts on eyewear
Aetna Medicare offers an annual allowance for the purchase of prescription eyewear, encompassing both prescription and non-prescription glasses. They also provide discounts for eye exams related to eyeglasses or contact lenses.
However, be aware that there are exclusions or limitations to the eyewear discounts provided by Aetna Medicare. These eyewear discounts cannot be combined with other promotions or discounts.
Contact lens allowance conditions
Certain Aetna plans offer a contact lens allowance of up to $150 for members, although most plans do not cover contact lenses and eyeglasses. The contact lens allowance for Aetna members amounts to $150 per year for conventional contact lenses, and it is a yearly benefit.
This allowance includes coverage for contact lenses designed for far vision, including cases of binocular and monocular aphakia. However, there are constraints on the utilization of the Aetna contact lens allowance, including limitations on discounts for balances exceeding the frame or conventional contact lens allowance.
Digital Tools for Managing Your Vision Benefits
Various digital tools are available through Aetna Vision Preferred to assist you in managing your vision benefits.
Aetna Vision Preferred is a digital platform comprising a website and an app designed to offer Aetna members comprehensive access to their vision plan details, encompassing claims updates, coverage information, and wellness tips.
The platform enables you to locate in-network eye doctors and avail special offers, thereby aiding in the efficient management of your vision benefits and certain network administration services.
Know before you go tool.
The ‘Know before you go’ tool by Aetna offers an estimation of the potential out-of-pocket expenses before a visit to a vision care provider. This tool takes into consideration insurance deductibles and out-of-pocket maximums.
It provides cost estimates for all types of vision exams and procedures, helping members evaluate different service options and additional features, aiding in the avoidance of unforeseen expenses and better planning for their vision care requirements.
Aetna Vision Preferred website and app
The Aetna Vision Preferred website and app offer members access to their vision benefit information, check vision benefits, find an eye doctor, view claims, and stay connected to benefits and special offers.
The website provides various benefits including eye opening savings, online shopping options with in-network providers, and exclusive members-only offers on eyewear, sunglasses, and supplies.
Members can access benefits and eligibility information, as well as locate in-network eye doctors by downloading the Aetna Vision Preferred app from the Google Play Store.
Staying Informed and Healthy During COVID-19
Amid the COVID-19 pandemic, Aetna has taken several measures to protect the well-being of its members, including enhancing certain claims administration services. These measures include:
- Categorizing services as ‘never effective’ if they fail to meet safety and effectiveness criteria
- Offering comprehensive COVID-19 benefits information on their website
- Exempting Medicare Advantage members from cost shares for COVID-19 screenings, tests, and provider visits.
Aetna offers its members a range of additional benefits and well-being resources specifically related to COVID-19, such as vaccine updates, testing information, and current case counts.
Summary
In summary, EyeMed Aetna Medicare Vision offers a wide range of benefits to its members, including comprehensive vision care, dental and hearing benefits, and exclusive savings on eyewear. The partnership between Aetna and EyeMed ensures a wide network of providers and a variety of services to cater to the members’ needs.
Regular eye exams are emphasized as a crucial part of maintaining overall health, with the ability to detect potential health issues such as diabetes and high blood pressure early on.
Digital tools provided by Aetna Vision Preferred make managing vision benefits easy and convenient for members.
Frequently Asked Questions
→ What is the difference between Aetna and EyeMed?
EyeMed and Aetna are independent contractors, and providers in the Aetna Vision network are credentialed through EyeMed Vision Care, LLC.
Aetna does not provide medical/vision care or treatment and is not responsible for outcomes.
→ Is VSP different from EyeMed?
Yes, VSP and EyeMed are competitors with different provider networks. You can compare their plans and provider networks to choose the one that best suits your needs.
→ Is Unum the same as EyeMed?
Unum Vision, powered by EyeMed, utilizes EyeMed’s network of providers, offering a mix of independent and retail providers, which includes national chains and online options.
Providers in the network are contracted through EyeMed for participation in EyeMed’s Insight Network.
The plans are marketed by Unum and EyeMed, administered by First American Administrators, and underwritten by Starmount Life Insurance Company.
→ What is the affiliation between EyeMed and Aetna?
EyeMed and Aetna have a professional relationship where EyeMed provides network administration services for Aetna Vision, operating as independent contractors.
→ What are the dental coverage options provided by Aetna Medicare?
Aetna Medicare provides dental coverage for preventive care like oral exams and cleanings, as well as comprehensive services including fillings and extractions.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.