Millions of Americans over 65 rely on Medicare to help pay for vital healthcare, such as doctor visits and medicine. With vision care being an essential need for the elderly, are these costs covered as well?
Original Medicare does not cover eye exams or glasses unless they meet certain criteria for being medically necessary in connection with specific medical conditions. However, Medicare Advantage does offer payment assistance for these costs.
Navigating the maze of coverages and exclusions in the Medicare system can be challenging, especially when it comes to vision care. Here is what you need to know when it comes to eye exams, glasses, and Medicare.
Does Medicare Cover Eye Exams and Glasses?
The simplest way to navigate through Medicare’s policies when it comes to vision care is to understand the basic rule and then recognize that there are limited exceptions that may apply to some patients.
Original Medicare does not cover routine eye exams for prescription glasses or contact lenses and allows for one simple vision test for new enrollees.
People who are enrolled in Original Medicare must pay 100% of the costs for such services.
Similarly, Original Medicare does not cover the cost of corrective lenses like eyeglasses and contact lenses, and enrollees must pay 100% of these costs.
That being said, several notable exceptions apply to Medicare coverage for eye exams and corrective lenses.
These are the Exceptions When Medicare Covers Eye Exams
There are limited instances when the costs of eye exams are covered by Medicare, but it should be noted that these are only applicable if you meet specific criteria.
Medicare will cover the cost of eye exams determined to be medically necessary to diagnose certain eye conditions.
Notable situations in which this exception applies include:
- For patients who have diabetes, Medicare will cover the cost of annual eye examinations to check for diabetic retinopathy, a condition affecting blood vessels in the eye
- Medicare will also cover the cost of annual eye exams if you are in a high-risk category for glaucoma (e.g., you are diabetic, glaucoma runs in your family, or you are Hispanic and over the age of 65)
- If you have been diagnosed with an age-related eye condition known as macular degeneration, Medicare will cover the costs of exams, tests, and certain types of treatment including injections
It is important to note that although Original Medicare allows for coverage of eye exams in the above instances, it does not cover 100% of the costs.
Even if you qualify and your medical condition falls under one of the noted exceptions, you must still pay your deductible, monthly premium, and 20% of the eye examination cost.
When are Eyeglasses Covered by Medicare?
Although Original Medicare (also known as Medicare Part B) does not normally cover the cost of eyeglasses or contact lenses, there is one notable exception when it will.
If you suffer from cataracts (a clouding of the lens in your eye) and require surgery to implant an intraocular lens (IOC), then Medicare will cover the cost of one pair of corrective lenses (either glasses or contact lenses).
As with covered eye exams, however, you will still incur some out-of-pocket costs as Medicare will cover most, but not 100%, of the cost of glasses or contacts under this exception.
What Coverage is Available Under Medicare Advantage?
If you are looking for more comprehensive healthcare coverage that goes beyond basic, medically-necessary care, then Medicare Advantage (also known as Medicare Part C) may be worth considering.
Under this hybrid plan that utilizes a network of private healthcare providers, additional services including dental, hearing, and vision, that are not included in Original Medicare, are included.
As far as vision care is concerned, most Medicare Advantage plans will cover:
- The costs of routine eye examinations for prescription eyeglasses and contact lenses
- Costs of corrective lenses (eyeglass frames, lenses, contact lenses)
Because Medicare Advantage is a supplementary program to Original Medicare, it has its own requirements as far as plan premiums, geographic coverage, and provider network.
It is therefore important to thoroughly research the Medicare Advantage options available in your area if you want to add vision coverage to your healthcare plan.
As we age, the development of vision problems and eye conditions are normal occurrences.
For millions of Medicare subscribers, vision and eye care are important considerations when deciding on the right plan for enrollment.
Original Medicare does not cover eye exams or corrective lenses except under certain circumstances, while most Medicare Advantage plans do cover them.
The key takeaway here is to consider your vision carefully and eye care needs when deciding which Medicare plan suits your overall healthcare objectives.