Does Medicare Cover Eye Exams?
With Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage...., you have coverage for all of the routine checkups and preventative care you need. But what about your eyes?
If you are wondering if your medicare benefits cover visits to the eye doctor, you might be surprised by the answer:
- Original Medicare doesn’t cover routine eye exams for eyeglasses or contact lenses.
- With Original Medicare, you pay 100% for eye exams and your corrective lenses.
- Some Medicare Advantage PlansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... offer routine vision care and corrective lenses.
- Both Original Medicare and Medicare Advantage cover medically-necessary vision-related treatments.
Keep reading to get a better grasp on which vision-related treatments Medicare does cover.
Age-Related Eye Problems
As we age, there are certain eye conditions people need to be aware of. Some age-related eye conditions include:
- Presbyopia–the inability to read the fine print (or see small objects clearly)
- Glaucoma–increased pressure inside the eye that can lead to blindness
- Cataracts–Cloudy buildup in the front part of the eye that can lead to vision impairment
- Retinal Disorders–problems with the retina that can interfere with the ability to transfer images
- Eye Injuries
So what does Medicare have to do with all of this? If our eyes will face inevitable problems with age, shouldn’t all Medicare plans cover all routine eye exams?
When Does Medicare Cover Eye Exams?
Original Medicare (Part AMedicare Part A is hospital inpatient coverage for people with Original Medicare, whereas Part B is medical coverage for doctor visits, tests, etc.... and B) do not cover routine eye exams. For most regular eye health checkups, you will have to pay 100% out of pocket or buy additional coverage.
Thankfully, Medicare Part BMedicare Part B is medical coverage for people with Original Medicare. It covers doctor visits, specialists, lab tests and diagnostics, and durable medical equipment. Part A is for hospital inpatient care.... does cover certain exams for age-related eye problems. Glasses, while important, are not as urgent as a glaucoma exam, and Medicare accounts for these specific needs as we age.
Medicare covers eye exams and, in some cases, surgery for these conditions:
1) Diabetes
Advanced stages of diabetes can lead to retinal problems, and eventually to blindness if left unchecked. If you have been diagnosed with diabetes, Medicare Part B will cover one exam annually to test for diabetic retinopathy.
2) Glaucoma
Medicare Part B also entitles you to an annual glaucoma exam if you have certain risk factors. For example, if you are over 50 and African American, over 65 and Hispanic, have diabetes or a family history of Glaucoma, you may qualify.
3) Macular Degeneration
Medicare also entitles you to exams and diagnostic tests, as well as medication, if necessary, for macular degeneration.
4) Eye Injuries and Diseases
Medicare will cover an injury to your eye just as it would an injury anywhere else. It also covers eye diseases and treatments such as Lucentis, Aflibercept, and ocular photodynamic therapy.
Medicare Advantage Plans
If you are fortunate enough to maintain healthy eyes, your doctor may not see a need to send you to an eye specialist. But if you still need the type of vision coverage that offers walk-in eye exams, look at the Medicare Advantage plans available in your area. They are not all the same.
Medicare Advantage plans are plans offered by private, Medicare-approved insurance companies. If you need insurance that covers eye exams (in some cases free eye), you can compare Advantage plans using the MedicareWireplan finder tool. Many plans also cover dental, hearing, and prescriptions, too.
Know Your Options
Does Medicare cover eye exams for seniors? Original Medicare does not, but many Medicare Advantage plans do. In addition to Medicare Advantage plans, you can also opt for stand-alone vision coverage or a dental and vision plan. The tools you need to find these plans are all available on MedicareWire.
Don’t wait until your primary physician sees that you have eye problems. If you are wondering, “Does Medicare cover eye exams?” The answer is yes, but you need to choose the right plan to get routine vision care.