One of the most common signs of aging is gradually worsening vision. Since this happens to nearly everyone by the time they turn 50, you would think that Medicare would cover routine vision services. Unfortunately, Medicare's eyecare coverage is extremely limited. So, when does Medicare cover vision? Keep reading to find out.
Does Medicare Cover Routine Eye Exams?
Original Medicare (Parts A and B) does not usually cover routine eye exams for the purposes of prescribing corrective lenses, i.e. glasses or contacts. However, if you meet certain conditions, Medicare may cover a variety of vision services. (Please see the sections below.)
In addition to paying for your eye exam out-of-pocket, you'd also need to cover 100 percent of the cost of prescription glasses or contact lenses.
You may be able to get routine vision coverage with a Medicare Advantage (MA) plan. See the section Does Medicare Advantage Cover Vision.
What Vision Services Does Medicare Cover?
Although it does not cover routine vision care, Original Medicare does cover a variety of vision services if you meet certain medical conditions. This includes people who have glaucoma, cataracts, and acute eye injury.
For example, if you have a chronic eye condition, Medicare covers surgery to help restore function. Patients experiencing onset vision problems qualify for an eye exam under Medicare Part B. This assumes the intent is to diagnose the cause of your vision problems (versus routine eye exams intended to prescribe glasses or contacts).
If you received an intraocular lens during cataract surgery and now need contact lenses or glasses, Medicare covers one standard pair of corrective lenses. Customized eyewear is only covered if your provider deems it medically necessary.
Medicare Part A covers inpatient hospital treatment if you're admitted to address an injury that affects your vision.
Vision Tests Covered by Medicare
If you have Medicare Part B, you're covered for a variety of preventive eye screenings and tests.
When Medicare Covers Diabetic Retinopathy Screenings
Medicare Part B covers a yearly eye exam for beneficiaries who have diabetes. Known as a diabetic retinopathy screening, the exam must be performed by a state-approved eye doctor. Your out-of-pocket costs include 20 percent of the Medicare-approved amount. In addition, the Medicare Part B deductible applies. You may also have a copay if the procedure is performed in a hospital outpatient setting.
Medicare Coverage for Glaucoma Screenings
Medicare beneficiaries who are considered high risk for glaucoma are eligible for a yearly glaucoma test. To be considered high risk, at least one of the following must be true:
- You have diabetes
- You have a family history of glaucoma
- You're an African American aged 50 or older
- You're a Hispanic American aged 65 or older
If you qualify for glaucoma screenings, you'll pay 20 percent of the Medicare-approved amount. You may also have a copay if you receive the test as a hospital outpatient. The Medicare Part B deductible also applies.
A state-approved eye doctor must either perform or supervise the glaucoma test.
Age-Related Macular Degeneration Tests and Treatment
Age-related macular degeneration (AMD) is a relatively common eye disease that may cause vision loss. Unlike age-related farsightedness, AMD affects your center field of vision.
Medicare Part B covers macular degeneration tests and treatment. The Part B deductible applies and you are responsible for 20 percent of the Medicare-approved amount for services. Additional out-of-pocket costs include a copayment if you receive services in a hospital outpatient setting.
Does Medicare Cover Glasses or Contact Lenses?
Medicare typically only covers prescriptive glasses or contact lenses if you need them following cataract surgery to implant an intraocular lens. In this instance, your costs include 20 percent of the Medicare-approved amount for a pair of standard corrective lenses. The Part B deductible also applies. In addition, you use a Medicare-approved supplier.
If you want to upgrade or customize your frames, you are responsible for 100 percent of the additional costs.
Please note that Medicare only covers the cost of cataract surgery that uses lasers or traditional surgical techniques.
When Does Medicare Pay for Eye Prostheses?
If you lose an eye or experience eye shrinkage due to trauma, surgery, or a birth defect, Medicare Part B covers eye prostheses (also known as artificial eyes). Your cost is 20 percent of the Medicare-approved amount. In addition, the Medicare Part B deductible applies.
Medicare also covers the replacement of your prostheses once every 5 years. In addition, your Part B coverage includes resurfacing and polishing the eye prostheses. Your out-of-pocket cost for these services is the same as for the original procedure: 20 percent and the Part B deductible applies.
Does Medicare Advantage Cover Vision?
Also known as Medicare Part C, Medicare Advantage plans provide the same coverage you get with Original Medicare, but most offer additional benefits as well. According to this study from the Kaiser Family Foundation, around 88 percent of Medicare Advantage plans provide routine vision services, including eye exams and corrective lenses.
Since they're offered by private insurance companies, not all Advantage plans provide the same level of coverage. When comparing Medicare plans, look closely at the benefits and costs of each plan to determine which is the right one for you.
Does Medicare Part D Cover Vision?
Your Medicare Part D or Medicare Advantage Prescription Drug plan may cover medications prescribed by your doctor to treat an eye condition. Check your plan's formulary to be sure.
Does Medigap Cover Routine Eye Care?
In a word, no, Medicare Supplement Insurance plans (Medigap) do not cover vision services. That's because Medigap policies are restricted to paying out-of-pocket costs for covered Medicare services. And since Original Medicare does not cover routine eye care, neither will your Medigap plan.
Please note that you cannot have both Medigap and a Medicare Advantage plan.
Comparing Your Medicare Plan Options
Our Find a Plan tool makes comparing your Medicare plan options easy. Just enter your location information and start date to review the Medicare Advantage, Part D, and Medicare Supplement plans that are available in your area. To be sure you're comparing apples to apples, look closely at the plan's benefits as well as its out-of-pocket costs.
To understand the true cost of a Medicare health plan, you need to look beyond the monthly premium. This includes coinsurance, copayments, and the annual deductible.
Find a Medicare Plan in your area
It's FREE with no obligation