Wellcare CalViva Health Dual Align (HMO D-SNP): Vision Care

Routine vision exams and standard eyewear. They say that life begins at 40, but so does faulty eyesight! Poor vision impacts safety, mood, and thinking.

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Cost

Copayments and coinsurance vary by service, see breakdown below.

Prior Authorization Required

Provider Referral or Order Required

Yes

How To Receive

Details on how to apply

Medicare Covered

$0 copay for all other eye exams to diagnose and treat diseases of the eye.
$0 copay for a Medicare-covered glaucoma screening.
$0 copay for Medicare-covered retinal exam for diabetic members.
$0 copay for Medicare-covered eyewear.
- 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.)

Non-Medicare Covered

Find an in-network provider here

$0 copay for 1 routine eye exam every year.
Unlimited pairs of prescription eyewear every year up to a maximum benefit of $100 every year. Covered eyewear includes any of the following:
- Eyeglasses (frame and lenses) or
- Eyeglass lenses only or
- Eyeglass frames only or
- Contact lenses instead of eyeglasses or
- Vision hardware upgrades

Note: Contact lenses fitting fee is covered by the plan. Maximum plan benefit coverage amount of $100 every year applies to the retail cost of frames and/or lenses (including any lens options such as tints and coatings).You are responsible for any costs above the benefit maximum for supplemental (i.e., routine) eyewear.* Medicare-covered eyewear is not included in the supplemental (i.e., routine) benefit maximum. Members cannot use their supplemental eyewear benefit to increase their coverage on Medicare-covered eyewear.

Availability

All preventive and basic services available annually; specialist care as ordered and authorized.

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Routine vision exams help to identify vision changes that may require prescription adjustments, of course, but they can also detect many other things—early sight loss, dry eye syndrome, astigmatism, corneal complications, cataracts, threats to the optic nerve, macular degeneration, glaucoma, and damage from diabetes. For more on these eye conditions, search our library catalog.

Many people believe that they see just fine, and perhaps they do. Most do not know, however, that they have actually lost their ability to see clearly at very close range or at farther distances. They may have also become so accustomed to issues with their eyes, that they have learned workarounds and accepted their difficulties as normal. Some eye complications, including serious threats to vision and eye health, are unknown until there is an irreversible problem and can only be caught early through a professional eye exam. Finally, modifiable factors that contribute to vision disturbances, such as certain medical conditions and medications, can also be addressed.

The plan covers several vision care needs.

1 routine eye exam every year
- Includes glaucoma screening for those at high risk (family history, diabetes, African Americans aged 50 and older, Hispanic Americans aged 65 and older)
- Includes diabetic retinopathy screening for those with diabetes
1 eye exam every two years for the purpose of getting corrective lenses
One pair of standard* eyeglasses (frames and lenses) OR contact lenses every year, but not both
Physician services (ophthalmology) for diagnosis and treatment of disease and injuries of the eye, including treatment for age-related macular degeneration
One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens
- If there are two separate cataract operations, the benefit cannot be reserved after the first surgery and two pairs of eyeglasses purchased after the second surgery

*Standard eyewear: eyeglasses include single-vision, bifocals, and trifocals; this excludes specialty lenses such as transition, tint, progressive, or polycarbonate; contact lenses include standard daily wear, extended daily wear, disposables, toric, or rigid gas permeable.

Coverage includes the replacement of lost or destroyed glasses and the repair or replacement of parts.

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