“Does Medicare cover eye exams?” This is a fairly common question with Medicare beneficiaries, especially as many older individuals who qualify for health insurance need contact lenses or eyeglasses to improve their vision.
The answer to the question depends on the Medicare plan you choose. This article will highlight the various Medicare parts and their specific coverage in terms of eye exams.
This will make it easy for individuals who need an eye exam to decide the most suitable Medicare plans to choose.
Will Medicare Cover Your Eyes Exams?
Potential eye problems can be avoided with timely eye exams, especially as people grow older. The chances of developing glaucoma, cataracts, and other vision problems tend to be higher with older people, which is why older adults need to understand what Medicare plans will pay for eye exams.
In general, Original Medicare, which includes Part A and Part B, does not cover routine eye care services, such as regular eye exams, vision tests, or eye refraction tests for contact lenses and eyeglasses.
In other words, you will pay 100% for eye exams for contact lenses and eyeglasses if you have Original Medicare.
However, Medicare may cover some vision care services, especially for people with chronic eye conditions. Here are some of the eye exams that may be covered:
Glaucoma is an eye disease that can cause severe damages to the optic nerve and may lead to vision loss.
People with a high risk of developing glaucoma include:
Individuals with a family history of glaucoma
Those with diabetes
African American people who have reached 50 years or older
Hispanic people who are 65 years or older
Medicare may cover glaucoma screening if you meet one or more of the above criteria. However, the eye exam must be performed or supervised by an eye doctor who is legally authorized to do so in your state.
Cataract appears as a dense cloudy portion in the eye’s lens. It makes it difficult for the eye to focus images, resulting in blurred or faded vision.
Generally, surgery is required to correct the condition and Medicare covers some parts of the procedure, including:
The cost of replacing the clouded eye lens with an intraocular lens.
Paying for contact lenses or eyeglasses following cataract surgery.
The cost of services and facilities for the placement of intraocular lenses.
While you can choose to receive the basic lens replacement and let Medicare cover the cost, this will only address the cataract. You can opt to correct far or nearsightedness during the surgery but Medicare doesn’t cover those additional services. You will have to pay the difference.
Other similar eye conditions, such as presbyopia and astigmatism, usually require the placement of lenses. However, Medicare does not cover services and facilities related to correcting these eye problems.
Diabetic Retinopathy Screening
Diabetic retinopathy is a condition associated with diabetic patients. It may start with mild vision problems but it can lead to blindness if left untreated.
Medicare covers eye exams aimed at identifying this condition, but you must meet the following conditions to be eligible for the screening:
You have diabetes.
You are enrolled in Medicare Part B.
Your state must legally authorize the eye doctor to perform the screening.
Macular Degeneration Test and Treatment
Macular degeneration is one of the leading causes of vision loss among older adults. Typically, this eye disorder can prevent you from seeing objects in front of you, making it difficult to read or drive a car.
Medicare may cover some of the tests for macular degeneration, especially if the eye disorder is age-related. In addition to tests, some parts of Medicare may also cover medically necessary treatments, such as eye drops, injected medications, and other outpatient prescription drugs.
Medicare may also cover the costs of monitoring the progress of age-related macular degeneration after the treatment.
Which Parts of Medicare Cover Eye Exams?
Here are the different parts of Medicare that may cover eye exams under certain conditions:
Medicare Part A
Part A, which is also known as Hospital Insurance, provides coverage for inpatient stays or hospitalization.
If you have an eye condition that requires admittance to a skilled nursing facility or a hospital, Medicare Part A may be able to cover your stay in the inpatient facility, even if it doesn’t exactly cover the cost of the eye exam or prescription eyewear.
Note that this is only possible if the hospital accepts Medicare and you are admitted after an official doctor’s order that clearly states that you need inpatient hospital care.
Medicare Part B
Medical Insurance (Medicare Part B) covers outpatient care, preventive and diagnostic services, medical supplies, and certain treatment services for health conditions.
Unlike Part A, most people will pay a standard premium, typically deducted from Social Security. People with Medicare Part B are responsible for 20% of all Medicare-approved costs after the yearly deductible.
Provided beneficiaries reach the yearly Part B deductible, they will have coverage for glaucoma screening once every 12 months, especially for those with a high risk of developing the condition.
Part B also covers retinopathy eye exams once every year for diabetic beneficiaries. Diabetic people have an increased risk of developing issues with their vision because the vessels supplying blood to the retina can be affected by diabetic retinopathy.
Other eye exams that may be covered by Medicare Part B include:
Testing and treatment of age-related macular degeneration (AMD).
The costs of AMD tests and some drugs injected into the eye during treatment.
Cataract surgery and the cost of the services and the facility during the surgery.
Eyeglasses and contact lenses if they are provided after a cataract surgery requiring the placement of an intraocular lens (IOL).
Eye prostheses (artificial eyes) for those who have eye shrinkage due to vision trauma, surgery, and birth defect. It also covers eye prostheses for those without eyes.
Medicare Part D
Medicare Part D covers outpatient prescription drugs. This plan is usually optional and is provided through Medicare-approved private companies.
This part of Medicare may cover medications required for treating eye conditions or providing eye care. These prescription drugs include some vision care-related products such as eye drops and medications for dry eyes, glaucoma, and eye infections.
Part D enrollees have to pay monthly premiums and yearly deductibles. Also, copayments apply for certain prescription drugs. The exact amount will vary depending on the plan you have. For this reason, it is important to compare Medicare Part D plans before choosing one that covers the type of eye medications you need.
Medicare Advantage (Medicare Part C)
Unlike the government-sponsored Original Medicare, Medicare Advantage is an alternative and more comprehensive health insurance offered through private companies.
Medicare Advantage (also known as Medicare Part C) offers almost all the benefits of Medicare Part A and Part B (apart from hospice care). Many of the Medicare Advantage plans also offer the benefits of Medicare Part D.
The major benefit of Medicare Advantage is that the plans usually have broader coverage than Original Medicare. They often cover prescription drugs, routine vision, hearing, and dental services.
Vision care benefit is the most common supplemental service among those who enroll in Medicare Advantage. According to a 2019 research, approximately 71% of Medicare Part C plans have some type of coverage for vision care, with hearing and dental services trailing behind with about 56% and 41%, respectively.
The exact coverage will vary by the Medicare Advantage plan you have, but in general, the vision care coverage offered by the plans may include:
Routine eye exams
Contacts and eyeglasses
Other vision correction products, such as fittings for frame and contact lenses.
Most Medicare Advantage plans tend to be more comprehensive than Original Medicare. However, they offer diverse premiums and copayments, depending on the specific plan you choose. It is crucial to compare the various plans before opting for one that suits your health needs and financial situation.
Hopefully, you have been able to figure out the answer to the question “does Medicare cover eye exams?”
If you are concerned about potential eye problems, it is best to enroll in Medicare plans that cover eye exams that will provide access to timely assessment and treatment to prevent permanent vision damage.
Medicare Part B is limited in its coverage but can work for people who are at a higher risk for certain eye conditions.
Consider Medicare Advantage (Medicare Part C) if you want a plan that covers additional vision benefits, such as contact lenses, eyeglasses, fittings for frames, and diagnostic or preventative vision services.
John E Chambers is an experienced financial advice expert. Born in Chicago, he has a master's in Industrial Finance, but he has spent decades offering investment advice to businesses and individuals alike. He is the founder of RetireeWorkforce.com and wants the website to be valuable for retirement advice. In addition, he writes articles that help users jump-start their retirement plans and choose the best investment options. If not pondering over stock market statistics or reading some magazines, you can find John spending time with his family. As an early retiree, John also offers unique insights into what post-retirement life is like.