Medicare is a health insurance program for people aged 65 and over and younger individuals with certain disabilities. It covers a range of medical services and treatments, but when it comes to eye care, things can get complicated. There are two main categories of care: routine and medically necessary. This article will explore whether Medicare covers eye care, what services are included, and what you can do to get the best eye care possible.
Does Medicare Cover Eye Care?
The short answer is that Medicare covers some eye care services, but not all. In general, Medicare will cover eye exams and treatments that are considered medically necessary. This means that if you have a medical condition that affects your eyes, such as glaucoma, or macular degeneration, Medicare will usually help cover the cost of your eye exams and any necessary treatments. Beneficiaries also ask, “Does Medicare cover cataract surgery?” Cataract surgery is a type of treatment for a medical condition and, therefore, is covered by Medicare. Medicare will also help cover basic framed glasses after cataract surgery.
However, Medicare typically does not cover routine eye exams and vision correction, such as eyeglasses or contact lenses. This can be a surprise for many people, as vision problems are quite common among seniors. If you need glasses or contact lenses to see clearly, you will need to pay for these out of pocket or through a separate vision insurance plan.
What Eye Care Services Are Covered by Medicare?
As mentioned earlier, Medicare covers eye exams and treatments that are considered medically necessary. This includes:
- Treatment and exams for eye diseases, glaucoma, cataracts, and macular degeneration
- Diagnostic tests, such as a dilated eye exam or a visual field test
- Eye surgery, such as cataract surgery or other procedures to treat eye diseases
- Injections to treat macular degeneration
- Yearly eye exams for diabetic retinopathy
In addition, Medicare will also cover certain preventive services that can help detect eye problems early on, such as a glaucoma screening test for individuals at high risk of developing the condition.
How much does Medicare pay?
Most Medicare Part B services apply toward the Medicare Part B deductible, which is $226 in 2023. After the deductible is met, Part B covers 80% of the cost. Preventive screening services are covered 100% by Medicare Part B. If you have a Supplement plan in addition to your Medicare, it will help cover the remaining costs after the deductible.
What Eye Care Services Are Not Covered by Medicare?
As mentioned earlier, Medicare does not cover routine eye exams and vision correction. This includes:
- Eye exams for glasses or contact lenses
- Eyeglasses or contact lenses
- Lasik surgery or other vision correction procedures
If you need these services, you can purchase a standalone vision plan or pay out-of-pocket.
What Can You Do to Get the Best Eye Care Possible?
If you have a medical condition that affects your eyes, it’s essential to get regular eye exams and follow your doctor’s recommended treatment plan. This can help prevent complications and improve your overall eye health. If you need help paying for your eye care, there are a few options available to you:
Medicare Advantage plans: Some Medicare Advantage plans offer additional benefits that can help cover the cost of routine eye exams and vision correction. Be sure to check with your plan to see what’s covered. If you have a Medigap plan, you cannot have an Advantage plan at the same time.
Vision insurance: If you need glasses or contact lenses or want routine eye exams to see if you need glasses or contact lenses, you can purchase an individual vision insurance plan to help cover the cost. Be sure to shop around and compare plans to find one that meets your needs.
Discounts: Some eye care providers offer discounts to seniors or individuals with certain health conditions. Be sure to ask your provider if they offer any discounts or payment plans that can help make your eye care more affordable.
Understanding Your Eye Coverage
In conclusion, Medicare can cover the necessary eye services to treat, diagnose or monitor a health condition. It’s important to understand what’s covered and what’s not so that you can plan for your eye care needs accordingly. If you have any questions or concerns about your eye care coverage, speak with your doctor or Medicare representative. You can maintain good eye health and enjoy clear vision well into your golden years with proper care and attention.
