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Spectacles for far vision or for near vision or.Note: Aetna covers medically necessary external and internal lenses as prosthetics for aphakic members even if the surgical removal of the member's lens occurred before the member enrolled in Aetna's medical plan.įor Medicare and HMO members, Aetna considers lenses or combinations of lenses medically necessary following cataract surgery to essentially restore the vision provided by the crystalline lens of the eye, including: In addition, an intraocular lens is considered a medically necessary prosthetic for individuals lacking an organic lens because of surgical removal (e.g., cataract surgery) or congenital absence (congenital aphakia). This includes post-surgical external lenses that are customarily used during convalescence from cataract removal surgery. Centers for Medicare and Medicaid Services (CMS) defines both types of lenses as “prostheses” replacing the lens of the eye. Medicare plans and HMO plans (HMO, QPOS)įor Aetna Medicare plans and Aetna HMO plans, Aetna follows Medicare's rules for prosthetic lenses.įor Aetna Medicare members and HMO members, Aetna considers external lenses (contacts or spectacles) and intraocular lenses medically necessary after cataract surgery.Prosthetic Contact Lenses and Eyeglasses for Aphakia.The eyeglasses are replaced because a different frame size or shape is necessary due to the child's growth, metal allergy or other justifiable medical reasons.With regular use, the previous eyeglasses were broken or marred to a degree significantly interfering with vision or eye safety or.There is a change in refractive error or.Under these plans, replacement lenses are considered medically necessary for children and adolescents when one or more of the following criteria are met:

Some plans include a pediatric vision benefit. Replacement Eyeglasses Under Plans With a Pediatric Vision Benefit.Please check benefit plan descriptions for details. Additional coverage of contact lenses and eyeglasses may be provided under the member's vision care plan, if any. Under medical plans with this exclusion, contact lenses are only covered under medical plans for a narrow set of therapeutic indications, as outlined below. Note: Many Aetna medical plans exclude coverage of contact lenses or eyeglasses.