Does Medicare Cover Eye Exams? 4 Exams Covered

Does Medicare Cover Eye Exams?

When people ask, “Does Medicare cover eye exams,” there are often talking about routine eye checks. But, unfortunately, in Medicare Part A & B (Original Medicare), there is no coverage for routine eye checks or recommendations for contact lenses or corrective glasses.

However, Medicare covers some kinds of eye examinations. Eye exams are a very vital part of detecting potential issues with vision.

This is especially important for senior citizens who are at risk of severe eye conditions such as glaucoma and eye cataracts.

So, you might wonder what types of eye exams are included? Which parts of Medicare cover eye checks? Read on, and we will look at these questions in detail and so much more.

What Is an Eye Exam?

An eye exam comprises several tests to assess your vision and check for eye impairments.

During eye checks, a physician can shine a bright light on your eyes and even request that you try and focus when looking through several lenses.

Each step of an eye exam assesses various aspects of your visual well-being. Eye exams are endorsed because issues can be identified in their initial stages when they’re most correctable.

Routine eye checks enable physicians to give you professional advice on adapting to visual changes and some tips on how to take care of your eyes moving forward.

Eye examinations can also indicate potential problems in your overall health.

4 Eye Exams Medicare Covers

In Original Medicare (Part A & B), there is no coverage for routine eye checks. However, Medicare covers some other kinds of eye checks, and they include:

1. Diabetic Retinopathy

Diabetic individuals can develop a disorder known as diabetic retinopathy. This condition occurs when increased blood sugar levels cause damage to the vessels supplying blood to your retina.

In some instances, this condition can cause visual loss. So if you have diabetes, Medicare will pay for one annual eye exam to check for diabetic retinopathy.

2. Cataract Surgery

Cataracts occur when the lenses in your eyes become clouded. Lenses help your eyes focus on various things, and the presence of cataracts can cause your vision to be fuzzy and pale.

Medicare cover some of the expenses in cataract surgery, such as:

The installation of an IOL (intraocular lens). This is a small and clear disc that replaces the lens that cataracts have infected.
A pair of contact lenses or spectacles after the IOL installation procedure.
The cost of hiring the facilities where the procedure will be done.

Note that Medicare only pays for the installation of typical IOLs. Some types of IOLs are meant to treat conditions such as presbyopia or astigmatism.

Medicare will not cover any expense related to the installation of IOLs for such conditions. Read more about the cataract surgery coverage of Medicare

3. Glaucoma

Glaucoma is a disorder that causes damage to the optic nerve, and it can potentially lead to visual loss. In addition, as you grow older, the risk of contracting glaucoma increases.

Medicare will pay for one annual eye exam to check for glaucoma for individuals who are highly likely to contract glaucoma. You are at risk of contracting glaucoma if:

Your family members have a history of getting glaucoma.
You have diabetes.
You’re an African American aged 50 or more.
You’re Hispanic aged 65 or more.

4. Macular Degeneration

Macular degeneration is a syndrome that causes visual loss for objects nearby. This can impact daily routines such as reading and driving.

Medicare pays for some but not all analytical checks and treatments if you contract macular degeneration because of old age.

Some of the treatments Medicare covers in macular degeneration include some types of injectable medications.

Which Other Eye Exams Does Medicare Cover?

Medicare also pays for eye problems related to disorders or injuries. Some of the other conditions that Medicare pays for include:

Eye infections such as conjunctivitis.
Detached retina.
Corneal disorder.
Eyelid disorder.
Parched eyes and allergies.

Which Parts of Medicare Pay for Eye Exams?

Medicare Part A

Medicare Part A pays for your accommodation in hospitals or other inpatient clinics. So if your eye exam requires you to spend a night in hospital, Medicare Part A will cover your stay.

Most individuals don’t pay premiums for Medicare Part A. So when they’re in the hospital, the amount they pay in coinsurance is based on the kind of hospital they went to and the length of their stay in the facility.

Medicare Part B

Apart from paying your yearly deductibles, you’re also liable for 20% of the Medicare-approved expenses. Medicare Part B pays for the eye checks illustrated above, such as

Diabetic retinopathy checks once every year.
Glaucoma checks once every year.
Macular generation checks and treatment.
Installation of typical IOLs during cataract surgery.
Contact lenses or spectacles are needed after cataract surgery.

Medicare Part C

Medicare Part C is also known as the Medicare Advantage plan, and Medicare authorizes private insurance providers to provide this plan.

Medicare Advantage Plan covers all the benefits in Medicare A & B and also benefits such as prescription drug coverage. Medicare Part C also covers visual benefits, and it will pay for:

Routine eye checks
Contact lenses
Spectacle frames and lenses

Note that the types of benefits and the costs in Medicare Part C vary depending on the plan you are subscribed to.

Therefore, it’s recommended that you carefully compare the programs offered in Medicare Advantage Plan before choosing one.

Medicare Part D

Part D is an elective Medicare plan that includes prescription drug coverage. Just like the Medicare Advantage Plan, Medicare Part D is also offered by private insurance providers authorized by Medicare.

Medicare Part D covers some prescription drugs needed after eye checks including medications for diabetic retinopathy, glaucoma, and eye infections.

Note that the copayments and drugs covered by Medicare Part D vary depending on your subscribed plan.

Therefore, it’s recommended that you carefully compare the programs offered in Medicare Part D to ensure that the drugs you need are covered.

What is Medicare?

Final Thought

Eye problems are widespread and increase with age; this makes eye exams vital to your general health and well-being.

For that reason, you need to understand your Medicare coverage choices to see which Medicare Plan is most suitable for you to access the eye care you need.

References

https://www.medicare.gov/coverage/eye-exams-routine

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Does Medicare Cover Eye Exams? 4 Exams Covered