As people grow older, it’s common for them to suffer from vision-related problems. So, as you’re researching Medicare and all that it offers, you may question if Medicare covers vision services. In this MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. article, we’ll explain which vision care service Medicare covers, and those that are not covered.
Original Medicare Part A and Part B Vision Coverage
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.Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. offer vision coverage, but it’s limited. In fact, most routine eye care is not covered by Original Medicare. However, 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). do include vision care, including routine vision services.
Medicare Coverage for Eye Exams
Does Medicare cover eye exams? No, Medicare does not cover eye exams. They will not pay for eye refraction, which is the type of eye exam that you would need to get glasses or contact lenses. But, Medicare does cover costly eye treatments, including cataract surgery (more here).
The cost of eye exams can be covered by either another insurance or the patient out-of-pocket.
Does Medicare Cover Any Eye Services?
In general, Medicare only covers vision services having to do with major medical conditions, such as glaucoma, diabetic retinopathy screening, and macular degeneration tests and treatment.
Glaucoma Screening Test
Medicare Part B covers glaucoma screening. The program only covers the cost once a year and only if you’re at high risk for glaucoma.
You’re considered high risk for glaucoma if you:
- Have diabetes
- Have a family history of glaucoma
- Are African American and 50+ years old
- Are Hispanic American and 65+ years old
If you fall into the risk factors above, Medicare may cover glaucoma screening or a glaucoma test as long as it’s performed by an eye doctor or an eye doctor supervising someone who is performing the exam.
If the glaucoma test is performed in a hospital, you will have to pay the copaymentA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..
Diabetic Retinopathy Screening
Medicare Part B covers annual vision exams for people who are at increased risk for diabetic retinopathy screening.
It’s important to know that Medicare Part B will only pay for this screening if:
- You are enrolled in Part B.
- You have a diabetes diagnosis.
- An eye doctor performs the exam.
Macular Degeneration Tests
Those who may have signs of macular degeneration may receive coverage for the macular degeneration test for diagnosis. Those eligible for the test may need to pay 20% of the Medicare-approved amountA Medicare-approved amount is what Medicare will pay for a covered service. Healthcare providers that agree to Medicare assignment accept the approved amount without excess charges. What Does Medicare-Approved Amount Mean? A Medicare-approved amount is... if they have reached the deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.. Just like with diabetic retinopathy screening, if the macular degeneration test is performed in a hospital setting, the patient may need to pay a copay.
Vision Coverage with Medicare Advantage Plans
Medicare Advantage (Part C) is an alternative to Original Medicare. It’s another way to get your Medicare benefits. Instead of receiving private-fee-for-service coverage from the government-run Medicare program, you receive managed care through a private insurance company.
As with Original Medicare, Medicare Advantage plans have copays and coinsurance out-of-pocket costs you pay when you use healthcare services.
The benefit of having a Medicare Advantage plan is that many of them offer routine vision exams. While it depends on the private insurance you choose, most will pay for annual exam exams, eyeglasses, contact lenses, and more without being at high risk for major eye conditions.
Knowing whether a Medicare Advantage plan offers the above benefits is important. This is why you should research the insurance providers you’re interested in choosing for your Medicare Advantage plan.
Keep in mind you will need to continue paying for your Medicare Part B premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. when you sign up for a Medicare Advantage plan. This is in addition to the premium you will need to pay for the Medicare Advantage plan. Since each plan varies in benefits and costs, shop for the plan that falls within your budget and needs.
Find Plans in your area with your ZIP Code
Vision Coverage with Medicare Supplement Insurance
Medigap plans (supplemental insurance) are in lock-step with Original Medicare. So, if Original Medicare won’t cover it, a MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. plan can’t cover it, either.
Vision Coverage through Medicaid
If you have both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. benefits, in most states you can get routine eye exams and other vision benefits through Medicaid, including your preventive care and additional benefits. Curious if you qualify and enrollment procedures? You can learn more about how to qualify for both Medicare and Medicaid in this article.
Citations & References:
- Macular Degeneration Coverage
- Diabetic Eye Exam Coverage
- Find a Medicare plan
- How It Works – American Academy of Ophthalmology
- EyeCare America – American Academy of Ophthalmology
- Resources for Eye Glasses – American Academy of Ophthalmology
- New Eyes for the Needy
- Apply for Eyeglasses — New Eyes for the Needy