Does Medicare Cover Eye Exams? 4 Exams Covered

Does Medicare Cover Eye Exams

When people ask, “Does Medicare cover eye exams?” they are often talking about routine eye checks. Unfortunately, Medicare Part A & B (Original Medicare) does not cover routine eye checks or recommendations for contact lenses or corrective glasses.

Medicare Part B covers certain types of diagnostic eye exams if a physician deems them medically necessary.

This is especially important for senior citizens 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 most correctable.

Routine eye checks enable physicians to give you professional advice on adapting to visual changes and tips on how to care for your eyes in the future.

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 covers the full cost of standard intraocular lenses during cataract surgery but does not cover the cost of premium intraocular lenses designed to correct presbyopia or astigmatism.

Medicare covers the cost of standard intraocular lenses but not specialized lenses like those for presbyopia or astigmatism, which may require additional out-of-pocket payment.

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 Part B covers an annual glaucoma screening test for individuals at high risk, such as those with diabetes, a family history of glaucoma, African Americans aged 50 or older, or Hispanics aged 65 or older.

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 covers certain treatments for age-related macular degeneration, including specific injectable medications under Part B.

Some of the treatments Medicare covers in macular degeneration include 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:

  1. Eye infections such as conjunctivitis.
  2. Detached retina.
  3. Corneal disorder.
  4. Eyelid disorder.
  5. Parched eyes and allergies.

Which Parts of Medicare Pay for Eye Exams

Medicare Part A

Medicare Part A covers hospital stays, so if an eye exam or treatment requires inpatient care, Part A will cover the hospital costs.

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

In addition to paying your yearly deductibles, you’re also liable for 20% of Medicare-approved expenses. Medicare Part B covers annual eye exams for diabetic retinopathy for patients diagnosed with diabetes.

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

Medicare Part C

Medicare Part C, also known as the Medicare Advantage plan, is authorized by Medicare to be provided by private insurance providers.

Medicare Advantage Plan covers all the benefits in Medicare A & B and also benefits such as prescription drug coverage. Many Medicare Advantage (Part C) plans offer additional benefits, including routine vision care, which may cover eye exams and eyewear.

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 the Medicare Advantage Plan before choosing one.

Medicare Part D

Part D is an elective Medicare plan that includes prescription drug coverage. Like the Medicare Advantage Plan, It is 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, making eye exams vital to 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.

See Also

Does Medicaid Cover Dermatology

Does Medicare Cover Shingles Shots

What is the NIH (National Institutes of Health)

Does Medicare Cover Chiropractic

Does Medicaid Cover Braces

Current Version
August 18, 2023
Updated By
Andrea Morales G.
April 15, 2024
Updated By
Andrea Morales G.

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