Does Medicare Cover Eye Exams?
Seniors over 65 are susceptible to eye diseases like macular degeneration, glaucoma, cataracts, and diabetic retinopathy. In fact, one-third of all adults at this age experience some level of vision loss. Losing your vision, or living with impaired vision, often means losing independence. Seniors who don’t have full independence at home because of difficulty seeing, are also at high risk for social isolation and depression.
To protect yourself from vision problems, it’s important to have access to routine vision care. Getting regular eye exams assist your physician in diagnosing vision-reducing diseases early and can reduce your risk of severe vision loss or blindness in certain cases.
Unfortunately, when it comes to covering routine eye exams, Medicare benefits fall short. Original Medicare Parts A and B cover some vision care services, but not those that are considered to be routine. If you want more comprehensive vision care coverage, you might consider enrolling in a Medicare Advantage (Part C) plan.
Do Medicare Advantage plans cover eye exams?
Medicare Advantage, or Medicare Part C, plans are sold by private insurance companies that work with the Medicare program. While they are required to provide the same benefits as Medicare Parts A and B, they have the option to include additional benefits like prescription drug coverage, routine dental, hearing, and vision care.
Private insurance providers selling Medicare Advantage plans recognize the importance of providing extra coverage like routine vision care, so many plans include these benefits. However, because these types of benefits are optional, you should look carefully at Part C plans available in your service area and compare plans to find the one that includes the vision care you need.
Medicare Advantage policies that provide vision care generally include services such as:
- Refractive eye exams to check for near-sightedness, far-sightedness, or astigmatism and to determine if corrective lenses are necessary
- Preventive eye exams
- Eyeglasses and contact lenses according to plan limits
- Upgraded eyeglass frames
Depending on the type of Medicare Advantage plan you enroll in, you may be restricted in the number of eye exams you can have annually. Also, your plan may require that you use ophthalmologists, optometrists, other health care providers, medical facilities, and suppliers that are included in the plan’s network of providers.
Before you make appointments for vision care, exams, or to purchase eyeglasses or contact lenses, make sure you have the details concerning your plan’s allowances. You can find this information on your printed policy, the insurance provider’s official website, or by calling a plan representative in your service area.
Your out-of-pocket costs depend on the amount of coinsurance your plan charges.
What vision care services does Original Medicare cover?
Apart from routine eye refractions, Original Medicare Part B (outpatient medical insurance) covers the following vision care services:
1. Eye exams for diabetic retinopathy one time per year. To be eligible, you must have diabetes.
2. Glaucoma exams one time every 12 months. To be eligible you must have any of the following high-risk factors for glaucoma:
- Family history of glaucoma
- African American heritage and over age 50
- Hispanic heritage and over age 65
3. Macular degeneration testing and treatment. This can include injections and drugs if you have age-related macular degeneration.
Additionally, Medicare pays for cataract surgery and corrective lenses afterward, surgery to repair a detached retina, and examinations and treatments for eye conditions when they are certified as medically necessary and not routine.
Original Medicare Part B pays for 80 percent of the above-mentioned services. You are responsible for the remaining 20 percent, as well as your Part B annual deductible.