Vision Coverage: How It Works with Medicare
Age can sometimes affect your eyes and weaken your vision. While some changes to the eyes are fairly common like cataracts and presbyopia, which makes it difficult to focus on objects up close, other conditions like glaucoma, diabetic retinopathy, and macular degeneration are more serious eye diseases. To help detect and prevent age-related eye conditions, routine eye exams should be an essential part of your health and wellness routine. But does Medicare cover vision expenses? Here is a breakdown of the vision services that Original Medicare Part A and Part B plans and Medicare Advantage plans cover.
Routine eye exams
Original Medicare Part A and Part B does not cover routine eye exams so you will have to pay out of pocket unless you have a supplemental insurance plan. However, Medicare Part B will cover an eye exam every 12 months if you have diabetes or are at high risk for glaucoma.
Though Medicare Advantage benefits vary by plan, these plans may cover routine eye exams.
Glasses, contacts, eye prostheses
Original Medicare Part A and Part B does not pay for eyeglasses (frames or lenses), contacts, or the cost of the exam to get the corrective lenses fitted. However, Medicare Part B will cover corrective lenses that may be required after cataract surgery. Prostheses (artificial eyes) are covered for all beneficiaries enrolled in Medicare Part B after you pay 20% for the prostheses and the deductible.
Many Medicare Advantage plans cover the cost of eyeglasses and contact lenses; some plans may even cover the cost of designer eyeglass frames.
Diagnostic and preventive vision screenings
- Glaucoma. Medicare Part B will cover a glaucoma screening once a year if you have diabetes, a family history of glaucoma, are an African American 50 and older, or are Hispanic American 65 and older. Beneficiaries will pay 20% of the cost for the screening once you’ve reached your Part B deductible, as well as any copayment. The screening must be performed by an eye doctor who is authorized to do the exam in your state.
- Macular degeneration. Medicare Part B covers vision tests to diagnose macular degeneration as well as treatment of the disease. Beneficiaries will pay 20% of the cost for prescription medications and outpatient services, as well as any copayment. The test must be performed by an eye doctor who is authorized to do the exam in your state.
- Diabetic retinopathy screening. Medicare Part B covers the cost of an annual eye exam for beneficiaries who have diabetes to screen for this eye disease. The exam must be performed by an eye doctor who is authorized to do the exam in your state.
Since Medicare Advantage must cover at lease the same levels of benefits as Medicare Part A and Part B, the above screenings and treatments are also covered by Medicare Advantage.
Age-related changes in vision can occur anytime age 60 and over, sometimes without symptoms. They can be severe enough to affect your quality of life or interfere with daily abilities like driving. That’s why seeking professional vision care for regular exams is important to maintain good eye health.
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