Original Medicare Coverage And Vision Testing
Original Medicare in general does not cover regular eye exams necessary for getting new or updated eyeglasses or contact lenses, according to Medicare.gov.
So, if you were to make an appointment strictly because you currently wear glasses or contacts and you notice that your vision is getting worselikely signifying that you need a new prescriptionthe exam would not be paid for by Medicare.
However, Medicare Part B will pick up some vision testing expenses in certain circumstances.
Want More Information On Medicare Coverage For Eyeglasses
If you need help finding Medicare coverage for prescription eyewear or contact lenses, I can show you Medicare Advantage plan options that include vision benefits. If youd prefer a phone call or email with personalized information, you can request that by using the links below. Or, to start researching on your own, hit the Compare Plans button to view plan options you may be eligible for.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
Medicare Vision Coverage And Medicare Advantage Plans
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 .
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.
New To Medicare?
Becoming eligible for Medicare can be daunting. But dont worry, were here to help you understand Medicare in 15 minutes or less.
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Help With Vision Care Expenses
A person may qualify for Medicaid, depending on their income and resources. Medicaid covers medically necessary eye care, including treatment for eye injuries and conditions. Routine eye exams are not typically included, but Medicaid does cover eye exams that a doctor deems medically necessary.
A person can contact their state Medicaid department to ask about assistance with vision care.
Even if a person does not qualify for Medicaid and has no coverage through Medicare, other resources can help with paying for vision care.
Some examples include:
- EyeCare America: This organization is part of the American Academy of Ophthalmology Foundation and provides eye exams for people with lower incomes.
- SightFirst: This program, operated by Lions Club International, helps people receive vision support, including eyeglasses.
- Mission Cataract USA: This program provides cataract surgery for people who may not otherwise be able to afford it.
- New Eyes for the Needy: This program helps people obtain single or lined bifocal lenses. A person needs to have an eye exam and receive a prescription before applying for the glasses.
Hearing Exams And Hearing Aids
Medicare doesn’t cover routine hearing exams, hearing aids, or exams for fitting hearing aids. Medicare Part B covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment. All people with Part B are covered.
Your costs in Original Medicare:
- You pay 100% for routine exams and hearing aids.
- You pay 20% of the Medicare-approved amount for the doctor’s services for covered exams, and the Part B deductible applies.
- In a hospital outpatient setting, you also pay the hospital a copayment.
Note: Some Medicare Advantage plans offer extra hearing benefits. Be sure to contact the plan for more information.
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Are Vision Benefits Part Of My Plan
Who is this for?
If youre shopping for a Medicare plan or need to find out if your current plan covers eye care, this information is for you.
Whether you have vision benefits depends on what type of Medicare plan you have.
- Original Medicare is run by the U.S. government. It does not cover routine eye exams, glasses or contacts. Medicare Part B covers some eye care related to diabetes, glaucoma and macular degeneration, as well as corrective lenses after cataract surgery. Otherwise, you will pay for routine eye exams, glasses and contacts out of your own pocket with Original Medicare.
- Private health insurance companies offer Medicare Advantage plans that include everything Original Medicare offers, plus extra benefits. They may include eye care. Your vision benefits will depend on what type of Medicare Advantage plan you have.
Medicare Part B Will Cover Corrective Lenses Under One Condition
If you have to get cataract surgery to implant an intraocular lens, Medicare Part B will help pay for corrective lenses. Part B will provide coverage for one pair of eyeglasses with standard frames or a single set of contact lenses, and you will pay 20 percent of the Medicare-approved amount for the lenses after each surgery. The Part B deductible will also apply.1
Coverage for lenses and glasses is limited outside of a Medicare Advantage plan so consider your eye health needs carefully when choosing Medicare coverage.
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Does Medicare Cover Eye Exams
Original Medicare, Part A and Part B, doesnt cover routine eye exams. Also known as an eye refraction, this is the type of exam youd normally have to get fitted for eyeglasses or contact lenses. In most cases, Original Medicare doesnt cover vision exams, eyeglasses , or contact lenses. If youre enrolled in Original Medicare and dont have other insurance, youll 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 youre at high risk for glaucoma.
Youre considered high risk for glaucoma if:
- You have diabetes.
- You have a family history of glaucoma.
- Youre African American and 50 years old or older.
- Youre Hispanic American and 65 years old or older.
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 whos legally authorized to perform the test in your state. Youll pay 20% of the Medicare-approved cost for the screening if your doctor accepts assignment. If you get the test in a hospital outpatient setting, youll also have a copayment.
Diabetic retinopathy screening
- Youre enrolled in Medicare Part B.
- You have diabetes.
- The exam is performed by an eye doctor whos legally authorized to do the exam in your state.
Do Medicare Advantage Plans Cover Eyeglasses
You may have other options as a Medicare beneficiary if youd like help covering the cost of eyeglasses. Medicare Advantage, also called Medicare Part C, is required by law to cover everything that Original Medicare covers, except hospice care, which is still covered under Part A. The main difference is that instead of getting your Part A and Part B benefits through the federal program, your coverage is administered through your Medicare Advantage plan, which is available through Medicare-contracted private insurance companies. Your costs may also be different than Original Medicare.
In addition, many Medicare Advantage plans offer additional benefits, including routine vision or dental, hearing services, or wellness programs. In many cases, you may be able to find a plan in your area that pays all or part of the costs associated with prescription eyeglasses, contact lenses, annual exams, or fittings. You may have to pay a deductible before your Part C benefits apply, depending on the plan. Not every Medicare Advantage plan includes vision benefits, so if youre interested in finding a plan with vision coverage, check with the specific plan before enrolling.
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Does Medicare Cover Treatment Of Macular Degeneration
Medicare Part B will cover certain diagnostic tests and treatment of diseases and conditions of the eye, which include treatment with certain injected drugs. Some people with age-related macular degeneration are covered by Medicare. You would be responsible for 20% of Medicare-approved amounts for diagnosis and treatment of diseases and conditions of the eye after the Part B deductible is applied.
Does Medicare Cover Vision Care For Diabetics
Vision problems are a common side effect of living with diabetes. Even if you manage your condition well, you can still develop secondary conditions. Medicare recipients may need to follow certain protocols in order to establish medical necessity for care that qualifies for coverage with their benefits.
Health Risks Associated with Diabetes
Although diabetes is a disease that impacts how your body controls and uses blood sugar, it can cause secondary health issues to develop over time. These complications span a wide range of organs and systems within the body due to the important role blood sugar, or glucose, plays in fueling muscles, tissues and brain function.
The National Institute of Diabetes and Digestive and Kidney Diseases lists your nerves, feet, kidneys and eyes at heightened risk for developing diabetes-related diseases. Diabetics are also more likely to develop heart disease and disorders with their bones and joints. The risk of Issues involving oral health, skin, sexual function and gastrointestinal organs may also increase.
Symptoms of Diabetic Eye Diseases
It can be difficult to catch diabetic eye diseases early on, as there are few symptoms that occur in the beginning stages of development. If any of the following symptoms occur chronically, you should talk to your doctor about an eye exam:
- Frequent shifts in vision clarity.
- Desaturated colors.
- Blurry, wavy or shadowy vision.
- Spots, light flashes or dark strings.
Treatment for Diabetic Eye Diseases
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Does Medicare Pay For Eyeglasses
As a general rule, original Medicare doesnt pay for eyeglasses. This means that if you need a new pair of glasses, youll likely pay 100 percent of the costs out of pocket.
However, there are some exceptions if you have Medicare Advantage or after youve had cataract surgery. Well explore the details of these exceptions next.
What Vision Benefits Does Medicare Part D Cover
You may need medications for an eye infection, allergies, or conditions like glaucoma or macular degeneration, or to diagnose and prevent eye diseases.
Eye medications often require a prescription. Some like artificial tears, eye drops, and ointments may be available over-the-counter, though youll need a prescription for Medicare to cover it.23
Medicare Part D covers medications via stand-alone Part D plans or MA plans.24 In 2019, 45 million people had opted for Part D coverage in 2019 almost half were in prescription drug plans .25Costs, policies, and covered medications vary widely depending on the plan.26
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How Much Does Vision Care Cost With Medicare
Vision care costs depend on what your needs are and what type of Medicare insurance you have.
With Original Medicare, you pay 100% for eye exams for eyeglasses or contact lenses. If you receive vision care that is medically necessary, Part B coverage kicks in and you pay 20% of the Medicare-approved amount for doctors services after you satisfy your annual Part B deductible . If the service is in a hospital outpatient setting, you also pay a copayment. Your total out-of-pocket costs will depend on:
- Other insurance you may have
- How much your doctor charges
- Whether or not your doctor accepts Medicare assignments
- The type and place you get your test, item, or service
To find out more about your out-of-pocket costs with Original Medicare, talk with your provider.
Vision care costs if you have a MA plan vary depending on your plan. All MA plans offer the same Medicare-covered, medically necessary benefits as Part B, but you typically have to receive care from in-network providers, and your copay/coinsurance structure may be different.
Whether you have Original Medicare or a MA plan, medically necessary vision care is considered a Medicare-covered benefit. You are eligible to receive services from approved providers, and you may be responsible for a portion of the costs in the form of a copay or coinsurance.
Does Medicare Cover Routine Vision Services
Medicare wont pay for routine vision services like eye exams, prescription glasses, or contact lenses. The only exception is if you have a medical condition that requires custom eyeglasses or contact lenses, in which case Medicare might pick up the tab.
On the other hand, Medicare Advantage generally covers standard vision testing, as well as glasses or contacts. If youre going to stick to original Medicare but want coverage for routine vision services, supplement insurance wont solve that problem Medigap wont pay for vision care or eyeglass benefits, either.
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Does Medicare Cover Eye Exams For Eye Injuries
If your eyes are damaged in an accident or injury, Medicare usually pays for diagnostic eye exams and tests to determine the nature and extent of the injury.
Generally speaking, Medicare covers medically necessary eye exams to diagnose and treat any diseases or conditions of the eye, such as an eye infection or a foreign body in your eye.
Do You Wear Glasses Youll Want To See This
According to the Vision Council of America, approximately 75% of adults use some sort of vision correction.1 Whether its eyeglasses, contacts or cheater readers, thats a pretty big number.
Given that number, you may be surprised to learn that, unlike most Medicare Advantage plans, Original Medicare does not cover routine vision care.
It does, however, cover medically necessary treatments that may improve or cure chronic eye conditions like glaucoma or cataracts. But you’ll need to check with your doctor to see if your condition makes the cut. For example, Lasik surgery for vision correction is not considered a medical necessity, so its not covered by Medicare.
Will Medicare Cover Macular Degeneration
Age-related macular degeneration is the leading cause of vision loss in adults 50 and over. Medicare Part B will cover diagnostic tests and treatment for AMD, which may include drops or eye injections. As is the case with other covered services, youll still be responsible for 20 percent of the cost of your services or treatment after meeting your deductible, so look to your Medigap plan for help there. Medicare Advantage will cover diagnostics and treatment for AMD as well.
Does Medicare Cover Dry Eyes And Allergies
Though having dry eyes wont necessarily impact your vision, it can be a painful condition that affects your quality of life. Medicare will generally cover an exam to diagnose the problem since its not considered routine, at which point youll be on the hook for 20 percent coinsurance on top of your Part B deductible. Your Part D plan might also cover medication to treat the condition, though in some cases, over-the-counter treatment will suffice. Youll get similar coverage with a Medicare Advantage plan, and Medigap can help with your out-of-pocket costs.
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Some Tests And Screening
Medicare Part B covers tests for glaucoma every 12 months if youre considered high risk, meaning:
- You have a family history of glaucoma.
- You are African American and 50 or older.
- You are Hispanic and 65 or older.
If Part B covers your glaucoma test, you must pay your deductible and then pay 20% of the Medicare-approved amount. Depending on where you get the glaucoma test, you may also have a copayment.16
Age-related macular degeneration is a condition that affects the part of your retina called the macula. AMD can cause loss of central vision, which makes it hard to focus on objects straight ahead.17
Diagnosing AMD may require a dilated eye exam that allows your doctor to look inside your eye. Other tests to identify AMD include a retinal scan or a test to study the blood vessels in your eye.18
Medicare Part B covers certain tests and treatments if you have AMD. You pay 20% of the Medicare-approved amount for tests and treatments that a Medicare-approved doctor performs after youve met your deductible. If you get AMD testing or treatment in a hospital clinic, you also have a copayment.19
Does Medicare Cover Vision Care Beyond These Three Types Of Eye Exams
Original Medicare typically does not cover:
- Contact lenses
- Routine eye exams
With Original Medicare, you may have to pay 100% for most eyeglasses and contact lenses, as well as routine eye exams.
Original Medicare may help pay for corrective lenses only after a cataract surgery with an intraocular lens. Typically, Medicare will only pay for contact lenses or glasses provided by a supplier that accepts Medicare assignment.
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Medicare Advantage Plans Might Cover Routine Eye Exams
Because Medicare Advantage plans must offer at least the same coverage as Original Medicare, these plans also cover the circumstances described above. However, some Medicare Advantage plans may offer additional coverage, which could include routine vision benefits. Certain Medicare Supplement insurance plans may also cover vision-related costs or provide additional eye coverage for an extra cost.
Does Medicare Cover Eyeglasses
As you get older, you may find that your eyesight isnt what it used to be, and its likely youll need corrective lenses at some point. According to the Centers for Disease Control , 92% of adults age 70 and older wear prescription eyeglasses. Roughly 1.8 million seniors report limitations in daily activities due to vision issues, including getting dressed or even walking around their home. In fact, CDC data suggests that vision problems may be a major risk factor in falls among the elderly.
Find affordable Medicare plans in your area
If youre a Medicare beneficiary, you may be wondering whether Medicare covers corrective lenses, such as eyeglasses or contact lenses. Unfortunately, if you are enrolled in Original Medicare and you need prescription eyeglasses or contact lenses, youll need to pay for these out of pocket in most cases. With a few exceptions, Original Medicare generally doesnt cover costs for routine vision care.
As an alternative to Original Medicare, you may be able to find a Medicare Advantage plan that includes vision coverage and helps with the cost of eyeglasses, including fitting exams, frames, and lenses. Read on to learn more about your coverage options.
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