The Shocking Truth: Does Medicare Cover Vision Care?
Nearly one in three older adults over the age of 65 suffer from some form of vision-reducing eye disease. These diseases include glaucoma, macular degeneration, cataracts, and diabetic retinopathy.
As you age, your risk for these diseases increases. However, Original Medicare does not include a comprehensive vision benefit. Understanding Medicare vision coverage allows you to protect your aging eyes and save money in the long run.
Does Medicare cover vision?
Does Medicare Cover Vision? | Medicare Plan Finder
Your vision is important, and we want to help you understand what Original Medicare (Part A and B) does and does not cover. If you have any additional questions, you can fill out this form, and a licensed agent will get back to you.
Does Medicare cover eye exams and glasses?
Generally, Medicare does not cover eye exams or glasses. This means that if you are only enrolled in Original Medicare (Part A and B) you will have to pay 100% of your costs, including the fees to have your frames fitted.
However, if you had cataract surgery to insert an intraocular lens, Medicare Part B may pay for corrective lenses. This can include a pair of glasses or contact lens, but you must get them through a Medicare supplier.
Medicare will cover the corrective lenses even if you had the cataract surgery before enrolling in Medicare. Plus, both lenses may be covered if you only had cataract surgery on one eye.
If your situation applies, you will pay 20% of the Medicare-approved costs after reaching your Part B deductible. If you want upgraded frames, you will be required to cover the additional cost.
Does Medicare cover eye care?
Routine eye exams, also known as refraction tests, are not covered by Medicare. However, if you have diabetes, your eye exam may be covered. Glaucoma tests and macular degeneration tests are often covered too. If you want coverage for eyeglasses, contacts, and exams, you should consider Medicare Advantage plans.
Medicare Advantage and Vision Coverage
Medicare Advantage plans must cover, at a minimum, the same benefits as Original Medicare. Medicare Advantage plans are growing in popularity because they can offer vision, hearing, and dental coverage.
Benefits will vary by plan, but an MA plan can cover routine eye exams, eyeglasses, contacts, and fittings. There are a few different types of MA plans, but if you are looking for vision coverage, a Medicare Advantage PPO is a good option. These are ideal because even though there is a network you should stick to, you have the freedom to see other providers.
You may not get as much coverage as you would by seeing in-network providers, but at least you have the option to visit a multitude of eye doctors. Want to learn more? Fill out this form, and we are happy to answer any of your questions.
Does Medicare Cover Vision Care? | Medicare Plan Finder
Glaucoma Treatment
Glaucoma is the cause of roughly 20% of blindness in the US. Most glaucoma cases occur in people over the age of 65. Glaucoma occurs when there is a build up of pressure in your eye. The pressure damages the major transmitter from your eye to your brain, also called the optic nerve.
There are a few different kinds of glaucoma based on how the pressure is accumulated into your eye. The main type of glaucoma is open-angle glaucoma and accounts for 90% of cases.
To treat glaucoma, your eye doctor may recommend eye drops to help relieve pressure. Another option is medication, usually a pill, that can work alongside eye drops to relieve the pressure.
The eye drops are typically used as short-term relief while the medications aim to work long-term and attack the parts of your eye that are contributing to the disease. The last resort to combatting glaucoma is surgery.
Is glaucoma testing covered by Medicare?
Part B covers a glaucoma screening once per year for those who are considered high-risk. You are considered high risk if one of the following applies:
You have diabetes
You have a family history of glaucoma
You are African American and 50+
You are Hispanic American and 65+
You will pay 20% of the cost for the screening after you reach your deductible. If you get the test in an outpatient setting in a hospital, you may also have a copayment.
Age-Related Macular Degeneration Treatment
Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in adults over 50. Caucasians have a higher risk of developing AMD and it is more common in women than men.
AMD occurs when there are changes to the macula (a small portion of the retina). There are two different types of AMD – “dry” and “wet”.
There is no treatment for “dry” AMD because the tissue in the macula becomes extremely thin and eventually stops working. “Wet” AMD occurs when the blood vessels leak fluids under the macula. If detected early, “wet” AMD can be treated with laser surgery.
Is Macular degeneration covered by Medicare?
Part B covers certain tests and treatments related to macular degeneration. This includes injection-based drug treatments. If you have age-related macular degeneration, you may be covered. If you are eligible, you will pay 20% for outpatient services after you reach your deductible.
Cataract Treatment
Man Discussing Cataract Treatment With His Doctor | Medicare Plan Finder
All of our eyes have a natural lens. The lens bends light rays that are directed at our eyes to help us see. The lens should be clear. If you have a cataract, the lens is cloudy. This makes your vision look blurry or hazy.
Prescription glasses can be used to correct your vision if the cataract is minor. However, sometimes glasses aren’t enough and cataract surgery is the most effective treatment. The operation involves removing your clouded lens and replacing it with a clear, artificial lens.
What does Medicare pay toward cataract surgery?
Medicare will only cover your cataract surgery if a doctor says it’s medically necessary. Medicare will also cover the related doctor visits after surgery. Unless you have a Medicare Supplement plan, you will be responsible for certain costs including deductibles, copayments, and coinsurance. To learn more about Medicare Supplement plans, send us a message!
Diabetic Retinopathy Treatment
Diabetic retinopathy occurs when the tissues in your retina are affected by blood vessels from high blood sugar. It is the most common eye disease among people with diabetes.
The vision loss from diabetic retinopathy is often irreversible, but early detection can reduce your risk by 95%. Treatment can include blood glucose management through a healthy diet, surgery, and medications like blood vessel growth inhibitors and steroids.
Does Medicare cover diabetic retinopathy?
As we mentioned, Medicare does not cover routine eye exams. However, Part B will cover an annual vision exam to check for diabetic retinopathy if you are enrolled in Part B, have diabetes, and the test is approved by an approved Medicare provider.
Other Vision Coverage Options
If you don’t want Medicare Advantage, you can purchase separate vision plans for seniors and Medicare eligibles. Vision policy premiums vary but are based on your age, health, and family history (disease risk). Most vision plans start at around $15 per month, but yours may be different. You may be able to save money by purchasing a vision plan that is combined with another benefit, like dental.
Private vision plans for seniors and Medicare eligibles and Medicare Advantage vision coverage both usually include annual exams, discounts for surgeries and services, and a specific allowance for glasses and contact lenses. Allowances will vary based on the plan you choose.
Losing Eyesight? Get Coverage!
If you are losing eyesight, now is the time to get vision coverage. Even if you have the healthiest eyes, Medicare Advantage plans can help you become the healthiest version of you.
Beyond vision coverage, they can also include dental and hearing coverage. Plus, some may offer fitness classes like SilverSneakers®! Our licensed agents can help you find the perfect plan that fits your needs and budget. Call us at 844-431-1832 or click here to get in touch with an agent!
Medicare Advantage | Medicare Plan Finder
Medicare for Diabetics and Diabetes Management
Diabetes is one of the largest health issues facing America and affects over 12 million older adults. In fact, the World Health Organization estimates that diabetes will be the seventh leading cause of death by 2030. The risk of developing diabetes increases with age, so it’s important to understand the role of Medicare and diabetes management.
Medicare for Diabetics and Medications
Medicare and Diabetes
If you are diabetic, or even pre-diabetic, your doctor may prescribe you medications like:
Metformin
Glucophage
Glumetza
Sulfonylureas
Meglitinides
Thiazolidinediones
Original Medicare (Part A and B) does not cover prescription drugs. If you are diabetic, you could end up having a high out-of-pocket cost for your medications. A Part D plan is a great alternative to help you save money and get the coverage for medications you need.
You can enroll in a Part D plan on top of your Original Medicare or purchase a Medicare Advantage plan. Medicare Advantage plans can offer benefits like prescription drug coverage, hearing, vision, or dental coverage and even things like meal delivery and transportation to doctor appointments or the pharmacy.
Does Medicare cover insulin?
Insulin can be divided into Original Medicare will only cover insulin that is needed for an external insulin pump and may be covered as Durable Medical Equipment.
Without insurance, the most popular form of insulin (Lantus) can cost over $500. According to GoodRx, the average copay for Lantus is $37.50-$67.70 with insurance.
Original Medicare does not cover other forms of insulin including pens, syringes, or needles. If you need other forms of insulin, a Part D plan or a Medicare Advantage plan with a prescription drug benefit can help!
What does Medicare cover for diabetics?
Medicare Part B covers diabetes self-management training (DSMT) for those who were recently diagnosed. Part B will also cover:
However, there may be limits on how much or how often you can get these supplies.
Medicare Part D covers diabetes supplies including:
Syringes
Needles
Alcohol swabs
Gauze
Inhaled insulin devices
Diabetic Supplies Delivered Directly to Your Door
You can get your diabetic supplies delivered directly to your door. However, you have to use an approved Medicare mail-order supplier if you want to utilize your Medicare coverage. If you prefer to purchase your supplies in a store, Medicare will cover the costs if you buy them at a Medicare-enrolled store or pharmacy.
Types of Diabetes and Symptoms
Patient with Diabetes and Medicare
If you are diagnosed with diabetes, it means that your body struggles to process the sugars in the foods you eat. As a result, your blood sugar levels rise. This means your body cannot produce enough insulin (or produce it in the right way) depending on which type of diabetes you have.
Type 1
Type 1 occurs when your pancreas cannot produce insulin (a hormone produced in the pancreas which regulates the glucose in your blood). It is typically developed at a young age and accounts for less than 10% of cases. If you have type 1, you will need to balance your blood sugar with insulin doses through a shot, pen, or pump. You will also need to pay close attention to the foods you eat and your daily activity level
Warning signs and symptoms of type 1 diabetes include:
Going to the bathroom more frequently
Being thirstier
Having mood changes
Struggling to see or other vision problems
Feeling fatigued
Losing weight without a change in diet or exercise
Type 2
Type 2 is the most common type of diabetes and accounts for 90% of diabetic patients. On the bright side, it is the most preventable and treatable form of diabetes. Unlike type 1, people with type 2 can produce insulin, just usually not enough. This means insulin shots, pens, or pumps may not be needed. Instead, you can monitor your blood sugar and manage insulin levels through medication.
The warning signs and symptoms of type 2 are very similar to type 1, they just take longer to develop. These symptoms include frequent urinating, thirst, mood changes, vision issues, fatigue, and unexplained weight loss. Some symptoms can take several years to surface which means regular check-ups and monitoring your blood sugar levels is crucial, especially if you are diagnosed with prediabetes.
Another sign of type 2 is prediabetes. If you are prediabetic, you probably have high blood sugar, and your body will start to reject insulin slowly. However, your blood sugar levels are not high enough to be considered type 2 diabetic just yet. Eating better, exercising, and losing weight can help prevent the development of type 2 diabetes in the future.
Effects of Diabetes
All types of diabetes should be taken seriously as they can have severe complications and effects on your body. Without proper treatment and management, diabetes can lead to the following health issues:
Heart Disease
Diabetes can raise your blood pressure and cholesterol. Nearly 75% of people with diabetes suffer from some sort of heart-related condition. This can include heart attacks, stroke, coronary heart disease, and many more.
Kidney Damage
Your kidneys are full of small blood vessels. Diabetes can damage these vessels, which impacts your kidney’s overall function. According to the National Kidney Foundation, 30% of type 1 diabetes patients will experience kidney failure.
Hypoglycemia
Hypoglycemia is when your blood sugar levels reach a dangerously low level. These low levels can result in falls, seizures, or even cause you to enter a coma.
Nerve Damage
High blood sugars can make it difficult for your blood vessels to take blood to certain parts of your body. If blood does not get to certain nerve endings, they can be partially or permanently damaged.
Eye Damage
Blurry vision is a warning sign of diabetes. This is because the blood vessels attached to your retinas are getting damaged. If diabetes is left untreated, this condition could worsen.
How to Test for Diabetes
If you have a body mass index over 25, are older than 45, or have been diagnosed with prediabetes, you should be tested for diabetes annually. The most common tests are as follows:
Glycated Hemoglobin (A1C) Test
This blood test shows your average sugar levels for the past 2-3 months. It measures the percentage of sugars attached to hemoglobin (an oxygen-carrying protein in red blood cells). The higher level of blood sugars equates to the higher number of hemoglobin with attached sugars. Two A1C tests of levels greater than 6.5% indicate diabetes. One A1C test between 5.7% and 6.4% indicates prediabetes. Anything under 5.7% is normal.
Random Blood Sugar Test
A random blood sugar test is exactly that – random. There is no fasting and it does not matter when (or what) you last ate. A blood sugar level of 200 mg/dL or higher indicates diabetes.
Fasting Blood Sugar Test
This test requires you to fast overnight. The next morning you take a blood sugar test. Sugar levels less than 100 mg/dL is normal. Anything between 100 and 150 mg/dL indicates prediabetes. If you take two separate tests at different times, and the results are over 126 mg/dL, you may have diabetes.
Oral Glucose Tolerance Test
This test requires you to fast overnight and check your blood sugar levels the next morning. Directly after, you will drink a sugary liquid. Over the next two hours, you will check your levels again. A level of less than 140 mg/dL is normal. After two hours, a level between 140 and 199 mg/dL indicates prediabetes, and anything over 200 mg/dL indicates diabetes.
How to Prevent Diabetes
You can’t change your genes, age, or past behavior, but you can take control of other factors, including:
Exercise: Did you know losing 10 kg (about 22 pounds) over a ten year period can lower your risk of diabetes by 33%? You should aim to get 30 minutes of exercise at least five days a week. If you haven’t been active, start slowly and work towards an overall goal.
Diet: A diet that is high in nutrients and low in glycemic loads are great for preventing diabetes. Green vegetables, beans, nuts, seeds, and fruit can help maintain your blood sugar. However, foods with added sugars, refined grains, and trans fats can have the opposite effect. Avoid fried foods and red meats when possible. Try a healthy soup!
Stress Less/Sleep More: When you are sleep deprived or have unusual sleep patterns, you increase your risk of obesity. As we previously mentioned, obesity plays a large factor in developing diabetes. Stress can impact your sleep schedule and make you toss and turn in the night. Plus, stress releases several hormones that increase your blood sugar. Pay attention to your sleep patterns and stress levels and visit a doctor if you have continued issues.
Diabetes and Medicare Coverage
Diabetes costs America more than $327 billion every single year. If you are diagnosed with diabetes, you may have high out-of-pocket costs. As we mentioned, Part D and Medicare Advantage plans can help save you money and provide the benefits and coverage you need. If you have any questions, or interested in enrolling in a Part D or MA plan, fill out this form or call us at 844-431-1832.
