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.
Medicare Vision Coverage
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 we will be sure to 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 pay for 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.
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.
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 833-438-3676 or click here to get in touch with a top agent!