Medicare does not cover routine eye exams to check your vision or prescribe corrective lenses. Medicare Part B does cover exams if you have an eye injury or diagnose conditions you are at high risk for.
Routine Eye Exams
Your annual visit to the eye doctor? Not covered. Medicare also offers no coverage for frames, lenses, or contacts. You pay the full amount for all of these healthcare services and items.
Diabetic Retinopathy
If you have diabetes, Medicare Part B will cover an annual eye exam to check for diabetic retinopathy if the exam is performed by a doctor licensed to perform the test in your state. You pay the regular 20% copayment for covered services as usual for Part B.
Glaucoma
If you have diabetes, a family history of glaucoma, are age 50 or older and African American, or age 65 or older and Hispanic, Medicare Part B will cover an exam for glaucoma once each year. When the exam is performed by a licensed physician, you are covered and pay 20% of the Medicare-approved amount for the service.
Macular Degeneration
If your physician believes you may have macular degeneration or if you have macular degeneration, Medicare Part B will cover eye exams and tests to diagnose macular degeneration. Medicare will also cover doctor visits related to the condition and certain injectable drugs used to treat the condition. You pay 20% of the Medicare-approved amount for these services.
Cataracts
Medicare covers exams to diagnose cataracts and treatment for cataracts.
Medicare also pays for cataract surgery. If you have a hospital stay, your Part A deductible applies in addition to Part B outpatient services. If you get an intraocular lens implant, Medicare Part B will cover one pair of prescription glasses or contact lenses after your cataract surgery.
Eye Injuries
Suppose you have eye damage from an accident or injury. In that case, Medicare will pay for diagnostic exams to determine the extent of the injury. Medicare will also cover exams to diagnose or treat conditions of the eye if they are medically necessary.
Medicare Advantage Vision Coverage
Routine vision care is a significant gap in Medicare coverage. If you are enrolled in both Part A and Part B and live within a plan’s coverage area, you can sign up for a Medicare Advantage plan. Medicare Advantage plans cover the same services, tests and items as Original Medicare. They can also offer additional benefits, and many plans do offer coverage for services not covered under Original Medicare, including vision, dental, hearing, and prescription drug coverage.
When you purchase vision coverage through a Medicare Advantage plan, it will help pay for annual eye exams, lenses, and frames. You pay an additional premium for this coverage.
Suppose you need vision care and are not getting the coverage you need through Original Medicare. In that case, Magellan Healthcare can help you find the plan that works for you. Contact us today to speak with an agent.
