Does Medicare Cover Scleral Lenses?

Scleral contact lenses are not like ordinary contact lenses. These are specialized to create a tear-filled vault over the cornea. Usually, these types of lenses are used to help with keratoconus.

However, the price of scleral contact lenses does not come cheap. So a common question many people have is, “Does Medicare cover scleral lenses?” In this article, we answer this question in clear, plain English. You will also find the average costs of scleral lenses, as well as other helpful info.

Does Medicare Cover Scleral Lenses?

The short answer is, no, in most cases, Medicare will not cover the cost of scleral contact lenses. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your scleral contact lenses.

Original Medicare (Medicare Part A and Part B) does not provide coverage for scleral contact lenses. This is because Medicare does not include routine vision care and dental care in its insurance programs.

The only exception is if your doctor considers the lenses medically necessary. So Medicare will not cover these lenses if they are for improving your vision.

However, they may cover scleral contact lenses if you require them after eye surgery. If they do, they will cover 80% of the costs for a scleral contact lens.

Some Medicare Advantage plans (Medicare Part C) may provide coverage for scleral contact lenses. These plans provide coverage for routine vision care and dental care. If you have a Medicare Advantage plan, reach out to your plan provider for the specifics of coverage for scleral lenses.

How Much Does Scleral Contact Lenses Cost?

Scleral lenses can be quite expensive. A big part of this is because they are custom made for your eye. Usually you will have to go for a fitting to get these lenses made.

On the low end, the lenses will cost around $400. Though some people report the lenses cost them $5,000 – $10,000 or more!

There will likely be a fitting fee on top of that. The fitting fee usually runs about half the cost of the lenses.

What Is A Scleral Contact Lens?

Scleral contact lenses are large-diameter gas permeable (GP) lenses. Unlike other contact lenses, scleral contact lenses cover up the entire corneal surface as well as the white portion of the eye (also known as the sclera).

They provide similar benefits to that of typical GP lenses. Those benefits include having better/sharper vision, they’re more durable than soft contact lenses, and there is a lower risk of complications. They are also easier to handle compared to soft contact lenses.

Scleral lenses are more comfortable to wear than soft lenses due to their stability. This is especially true for those who have sensitive eyes and irregularly shaped corneas.

Types Of Scleral Contact Lenses

There are three types of scleral contact lenses, and they differ mainly in size. Those three types of scleral contact lenses are:

Corneo-scleral lenses and semi-scleral lenses
Mini-scleral lenses
Full scleral lenses

Corneo-scleral lenses and semi-scleral lenses rest up near the junction between the cornea and the sclera.

On the other hand, mini-scleral lenses cover the whole corneal surface along with the entire anterior sclera.

Full scleral lenses provide the largest amount of space between the back surface of the lens and the cornea.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.