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It’s common to have age-related vision loss as you get older, and as a Medicare beneficiary, you may be wondering what type of vision services and items you’re covered for.
Original Medicare, Part A and Part B, offers limited vision coverage, and you’re not covered for most routine eye care. However, some Medicare Advantage plans may offer additional benefits, which can include routine vision care.
Here’s an overview of Medicare coverage of vision services.
Original Medicare, Part A and Part B, doesn’t cover routine eye exams. Also known as an eye refraction, this is the type of exam you’d normally have to get fitted for eyeglasses or contact lenses. In most cases, Original Medicare doesn’t cover vision exams, eyeglasses (frames or lenses), or contact lenses. If you’re enrolled in Original Medicare and don’t have other insurance, you’ll have to pay for these costs out of pocket.
Medicare does cover some diagnostic and preventive vision screenings in certain cases. Below are a few examples of situations where you might be covered.
Medicare Part B covers a glaucoma screening once a year if you’re at high risk for glaucoma.
You’re considered high risk for glaucoma if:
If you meet one or more of the above eligibility criteria, Medicare may cover the glaucoma screening. The glaucoma test must be given by or under the supervision of an eye doctor who’s legally authorized to perform the test in your state. You’ll pay 20% of the Medicare-approved cost for the screening (after reaching the Part B deductible) if your doctor accepts assignment. If you get the test in a hospital outpatient setting, you’ll also have a copayment.
Diabetic retinopathy screening
While Medicare doesn’t cover routine eye exams, Part B does cover an annual vision exam to check for diabetic retinopathy. You’re covered for this exam if all of the following are true:
Macular degeneration tests and treatment
According to the National Eye Institute, age-related macular degeneration is the leading cause of vision loss among individuals 50 and older. Medicare Part B covers vision tests to diagnose macular degeneration. You’re also covered under Part B for medically necessary treatment, including outpatient prescription drugs (such as certain injected medications).
Certain people with Medicare Part B and age-related macular degeneration are covered. If you’re eligible, you’ll pay 20% of the Medicare-approved amount for prescription drugs and outpatient services (after reaching the Part B deductible). If you get these services and treatment in a hospital outpatient setting, you’ll also owe a copayment.
Medicare doesn’t typically cover the cost for eyeglasses (both frames and lenses) or contact lenses, and you’ll normally have to pay the full cost for these items, as well as exams to get fitted for them. However, if you get cataract surgery to insert an intraocular lens, Medicare Part B covers corrective lenses following your surgery. You’re covered for either one pair of glasses or contact lenses if you get these items through a supplier that is enrolled in the Medicare program.
All beneficiaries with Medicare Part B are covered, and you’ll pay 20% of the Medicare-approved cost for the eyeglasses or contact lenses (after reaching the Part B deductible). If you decide to upgrade your frames, you’ll pay for any extra costs.
Medicare covers eye prostheses (artificial eyes) for beneficiaries without an eye or who have eye shrinkage because of birth defect, vision trauma, or surgery. You’re also covered for polishing and resurfacing of your artificial eye. Medicare will pay for a replacement once every five years.
All people enrolled in Medicare Part B are covered. You’ll pay 20% of the Medicare-approved amount for the eye prostheses, and the Part B deductible applies.
Medicare Advantage plans are an alternative to the government-run Medicare program and provide another way to get your Original Medicare, Part A and Part B, benefits. Offered through private insurance companies that are contracted with Medicare, these plans are required to cover at least the same level of benefits as Medicare Part A and Part B (with the exception of hospice care, which Part A still covers).
However, one benefit of Medicare Advantage plans is that they may offer coverage that goes beyond Original Medicare, including routine vision or dental, hearing, and prescription drugs. Benefits vary by plan, but Medicare Advantage plans may cover routine eye exams, eyeglasses, contacts, and fittings for frames and contact lenses; this coverage would be in addition to all of the preventive or diagnostic vision services and treatment covered under Original Medicare. Since each Medicare Advantage plan may offer different coverage, always check with the individual plan to see if vision benefits are included and what your costs may be. You still need to continue paying your Medicare Part B premium if you sign up for a Medicare Advantage plan, in addition to any premium the plan may charge.
Would you like help finding a Medicare Advantage plan that includes vision coverage? Feel free to browse Medicare plan options from the convenience of your home; the eHealth plan finder tool on this page makes it easy to do so. Or, if you prefer, give us a call to speak with a licensed insurance agent and get help finding Medicare coverage that may fit your situation.
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