Taking care of your vision is non-negotiable for your overall health and safety. As we age, it’s common for our eyesight to change—regular eye exams help maintain clear vision. But without a Medicare Advantage plan, you could be responsible for covering the total costs of eye exams and corrective lenses.
Knowing Medicare’s coverage for eye care is essential for beneficiaries, especially those requiring regular eye exams. This blog will concisely summarize what is and isn’t covered under Medicare.
Medicare and Eye Exam Coverage
Does Medicare B pay for eye exams? How about Medicare A?
Original Medicare Parts A and B do not cover routine exams for getting glasses or contact lenses. However, if you’re at a higher risk for certain eye conditions, like glaucoma, or if the exam is necessary due to an existing medical issue, Part B will help cover some of those costs.
Medicare does provide coverage for essential eye surgeries. Since routine vision care can accumulate, these expenses aren’t included under Original Medicare.
Fortunately, there are options for beneficiaries. Many private insurance companies offer vision and dental coverage packages that can nicely supplement Original Medicare, Medicare Supplement, or Part D plans. Alternatively, Medicare Advantage plans often include routine vision and dental care, with added options to customize your coverage based on what you need.
Coverage for Specific Eye Conditions
Medicare Part B covers certain eye conditions, perfect for individuals at risk or with specific diseases.
Diabetic Eye Exams
Medicare Part B helps cover a yearly diabetic eye exam for individuals diagnosed with diabetes, including those with diabetic retinopathy. To qualify for coverage, the exam must be performed by an eye doctor who is legally allowed to conduct the test in your state. After meeting the Part B deductible, you are responsible for 20% of the Medicare-approved amount for these exams. A copayment may also apply if the exam occurs in an outpatient hospital.
Glaucoma Testing
For those at high risk of developing glaucoma, Medicare Part B covers a glaucoma test once every 12 months.To be classified as high-risk, you must meet at least one of the following criteria:
- Have diabetes
- Have a family history of glaucoma
- Be African American and 50 years old or older
- Be Hispanic and 65 years old or older
Like diabetic eye exams, after satisfying the Part B deductible, you will pay 20% of the Medicare-approved amount, with additional copayments for hospital outpatient settings.
Macular Degeneration Testing
Medicare Part B may help cover certain tests and treatments for age-related macular degeneration (AMD). If you have AMD, you may receive coverage for applicable tests following the same payment structure—20% of the Medicare-approved amount after meeting the deductible and potential copayments for services rendered in outpatient hospital settings.
Coverage for Cataract Surgery
Does Medicare cover cataract surgery? Yes, as long as you follow the appropriate steps.
Medicare Part B not only helps with the cost of corrective lenses following cataract surgery but also covers the surgery itself. If you need cataract removal, Medicare can assist with your expenses, provided you have a documented diagnosis and the surgery is considered medically necessary. Once you meet your Part B deductible, you’ll usually pay 20% of the Medicare-approved cost for the surgery, plus any additional copayments for outpatient services.
Glasses and Contact Lenses
Medicare typically does not cover the cost of eyeglasses or contact lenses. However, as mentioned above, if an individual undergoes cataract surgery and has an intraocular lens implanted, Medicare will assist with the cost of one pair of corrective lenses, subject to the Part B deductible.
Medicare Advantage Plans
Some Medicare Advantage plans may offer additional vision coverage, including routine eye exams and prescription eyewear. Beneficiaries must review their specific plan details as coverage can vary widely. Many plans may include comprehensive vision care options, which are best for regular eye care.
How Much Do Eye Exams Cost Without Insurance?
Without insurance backing, the cost of an eye exam can vary. On average, you might expect to pay a couple hundred dollars for a comprehensive eye exam. However, prices can fluctuate depending on various factors, including the type of provider you choose, location, and whether additional testing or services are required.
How to Save on Vision Care
Even with Medicare coverage, out-of-pocket expenses for vision services can accumulate. Beneficiaries are advised to consult official Medicare resources or speak with a licensed insurance agent for more detailed information on what Medicare covers regarding eye care.
Griffey Eye Care & Laser Center accepts most insurance plans, and if your plan requires a referral, we can assist with that process. We accommodate various payment methods, including cash, checks, major credit cards, and flexible financing options through Alphaeon and CareCredit. Contact an eye doctor in Chesapeake, VA, at 1-888-873-9348 for help or to book your appointment through our website.
**Please note that the suggestions provided in this blog are for general informational purposes only and may not be suitable for your specific insurance plan and insurance needs. It is important to consult a qualified healthcare professional for personalized advice and treatment.**
