ORIGINAL MEDICARE
Does Medicare Cover Eye Exams and Vision Care?
Medicare does not cover some services when it comes to vision care. Depending on your Medicare plan, coverage for routine services can vary. As you start to consider your long-term options for Medicare, it’s important to know the details of your coverage.
Exams
One of the most commonly questioned services are routine eye exams. Eye exams are a necessary part of long-term vision care. Because of this, many people assume that Medicare will cover them.
Most insurance companies do now offer vision coverage, although this was not always the case. Unfortunately, Medicare does not cover routine vision exams, or exams to determine whether you need eyeglasses.
Preventative and Diagnostic Exams
However, Medicare Part B may cover some preventative and diagnostic exams. Here are a few of the scenarios in which Medicare will cover vision care.
Retinopathy
Medicare will cover an annual eye exam for diabetic retinopathy if you have diabetes. Retinopathy is a risk for diabetic patients. It is damage to your blood vessels in the retina caused by high blood sugar levels. The Part B deductible will apply, and you will pay a 20% coinsurance. If you have a Medigap plan, the coinsurance can be picked up by them.
Does Medicare Cover Eye Care for Diabetes?
While routine vision care is not covered by Medicare, diabetics at risk for glaucoma are covered for an eye exam every 12 months.
Glaucoma
A glaucoma test every year is covered for those at risk for glaucoma. This disease can cause serious damage to the optic nerve. If you have diabetes, a family history of glaucoma, or are African American or Hispanic American, you could be considered at risk for glaucoma.
Other Non-Routine Vision Care
Besides exams, there are other reasons that Medicare will cover a service for disease or damage to the eyes. Here are a couple of those circumstances.
AMD
Age-related macular degeneration is a root cause of many central vision issues. It is caused when the macula, a part of the retina, is damaged. If you have AMD, Medicare may cover your vision care.
Cataract Surgery
Cataract surgery means that the eye’s lens has gone cloudy and needs to be removed. In the case of cataract surgery, the eyewear necessary post-surgery will be covered where traditional eyewear will not. If the cataract surgery is to implant an intraocular lens, Medicare Part B will help cover corrective lenses. This could be glasses or contacts.
Does Medicare Cover Lasik Eye Surgery?
Medicare does not cover Lasik Eye Surgery. Lasik eye surgery, or laser cataract surgery, uses a laser beam to change the shape of the cornea. This helps your eyes to focus better. Unfortunately, this process is considered vision enhancement and not thought to bemedically necessary by Medicare.
Coverage for Routine Vision Care
Coverage is available for routine vision care. There are a few ways that you can get coverage for routine vision care.
Medicare Advantage Plans
Some Medicare Advantage Plans will cover routine vision care. However, this is dependent on the plans available in your area. You will also still need to pay the premiums for your Medicare Part B plan.
For your routine appointment, if covered by a Medicare Advantage plan, you will just need to pay a copay. Just remember these benefits can change from year to year.
Individual Dental, Vision, and Hearing Plan (DVH)
An individual insurance plan allows you to purchase insurance for routine vision care at an affordable price.
In many cases, individual insurance plans will bundle dental, vision, and hearing into a routine care coverage plan designed specifically for Medicare patients since these services are not covered by Medicare.
As with any insurance bundle, some companies can provide higher quality coverage suited to your needs than others. To find out more about individual plans, fill out the form at the end of this post.
Does Medigap Pay for Vision?
Medigap plans do not pay for routine vision care. There a good way to help with out-of-pocket costs when it comes to Medicare.
Medigap is limited, however, to picking up out-of-pocket costs for services already approved by Medicare. A Medigap plan will in some cases cover deductibles, copays and coinsurance for services already covered by Medicare.
Medicare Part D Vision Benefits
Medicare Part D is for prescription drug coverage. You can sign up for Medicare Part D alongside your Part A and B coverage. They are available through private companies which are approved by Medicare.
For those with vision care needs, Part D can cover certain items that will be helpful to your care. Eye drops and vision medications prescribed by a doctor could be covered by your Medicare Part D plan.
Vision care is a crucial part of your long-term healthcare. As you age, your eyesight needs to be closely monitored so that you can maintain your vision and avoid complications.
To make sure you are covered for vision care, you will want to explore an individual vision plan to supplement your Medicare plan.
To find the plan that’s right for you, fill out the form here and start receiving information on individual insurance plans and compare rates for vision care.