Does Medicare Cover An Annual Eye Exam

Medicare Vision Benefits Medicare Part D

Get Medicare with Vision Coverage from UnitedHealthcare

Medicare Part D offers prescription drug coverage, which you can sign up for to work alongside your Medicare Part A and Medicare Part B coverage. Medicare Part D Prescription Drug Plans are available from private, Medicare-approved insurance companies. A Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan may cover certain products related to vision care, like eye drops or other vision medications prescribed by a doctor.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.

What Is The Medicare Coverage For Eye Care And Eyeglasses

Understand Medicare coverage, costs, and options for vision care and corrective lenses.

Contributing expert:Kelly Blackwell, Certified Senior Advisor®Updated: April 16, 2022

Kelly Blackwell

Kelly Blackwell is a Certified Senior Advisor ®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.

Medicare Advantage With Vision Care

Medicare Advantage plans combine all the benefits of Original Medicare Parts A and B, and they are free to offer extra services as part of the same package.

Part C plans are offered by private insurance carriers, and they entirely replace beneficiaries Original Medicare plans and cannot be combined with a Medicare Supplement plan.

Seniors can shop around for a Medicare Advantage plan that offers vision coverage and speak with a plan representative about covered benefits. Medicare Advantage plans that include routine vision coverage may include an allowance for eyeglasses or contact lenses, as well as an annual vision exam.

You May Like: Does Medicare Cover Hospice Expenses

Help With Vision Care Expenses

A person may qualify for Medicaid, depending on their income and resources. Medicaid covers medically necessary eye care, including treatment for eye injuries and conditions. Routine eye exams are not typically included, but Medicaid does cover eye exams that a doctor deems medically necessary.

A person can contact their state Medicaid department to ask about assistance with vision care.

Even if a person does not qualify for Medicaid and has no coverage through Medicare, other resources can help with paying for vision care.

Some examples include:

EyeCare America: This organization is part of the American Academy of Ophthalmology Foundation and provides eye exams for people with lower incomes.

SightFirst: This program, operated by Lions Club International, helps people receive vision support, including eyeglasses.
Mission Cataract USA: This program provides cataract surgery for people who may not otherwise be able to afford it.
New Eyes for the Needy: This program helps people obtain single or lined bifocal lenses. A person needs to have an eye exam and receive a prescription before applying for the glasses.

Does Medicare Cover Eye Prostheses

Eye prostheses are covered for patients with absence or shrinkage of an eye due to birth defect, trauma or surgical removal. Medicare covers polishing and of the artificial eye, and typically covers replacement every five years.

You pay 20% of Medicare-approved amounts after the Part B deductible is applied.

What Is A State

A state-licensed doctor is a person licensed to practice medicine or osteopathic medicine and surgery in the state that they have been approved to operate in.

This will be covered under Medicare Part B, which means youll first have to pay your annual deductible. The patient will also have to pay 20% of the costs while Medicare covers 80%.

It is important to note that if your doctor suggests more tests, this service is only covered once a year.

How Much Do Vision Services Cost With Medicare

The cost of eye care, including an eye exam, depends on factors such as:

Your insurance, because Original Medicare doesnt cover most routine vision services, but many Medicare Advantage plans do.
The doctor or facility because some charge more than others.

The services you receive. A routine eye exam may cost less than getting fitted for glasses or contact lenses.

To get the most accurate estimate of your out-of-pocket costs, start by contacting your insurance provider to understand what services are and arent covered. Then, talk to your eye doctor to learn about the cost of the exam and any other tests or services.

Does Medicare Cover Eye Exams

Traditional Medicare will cover routine eye exams from medical professionals only when certain conditions are met. If a senior is at high risk for developing eye disease or vision problems because they have diabetes, have a family history of glaucoma, or are a part of an ethnic group defined as high risk, they will receive partial coverage for routine eye exams related to those conditions.

For seniors who do not meet the above requirements, Medicare Part B does not cover routine eye exams. If you are concerned with monitoring your vision as you age and seeking out routine vision tests as a form of preventative healthcare, you will need to pay for testing and exam costs completely out of pocket.

However, there are other options for seniors without diabetes or a history of glaucoma who want to get coverage for eye exams. Optional Medicare Part C, or Medicare Advantage plans, often cover routine eye exams and other vision related health services. Enrolling in a Medicare Advantage plan that offers Medicare vision coverage is an excellent way for seniors who want to monitor their vision as they age or who already wear glasses or contacts to ensure they get the coverage they need.

Want to make sure youre getting the vision coverage you need through Medicare? Our agents are available to answer your Medicare questions at .

Compare The Best Insurance Quotes In The Country

Eye On Health: Medicare Enrollment

Compare quotes from the top insurance companies and save!

Secured with SHA-256 Encryption

Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.

Chris Tepedino is a feature writer that has written extensively about home, life, and car insurance for numerous websites. He has a college degree in communication from the University of Tennessee and has experience reporting, researching investigative pieces, and crafting detailed, data-driven features.His works have been featured on CB Blog Nation, Flow Words, Healing Law, WIBW Kansas, and C…

You May Like: Does Medicare Cover Skin Removal

Will Medicare Pay For Treatment For A Detached Retina

A detached retina can cause permanent vision loss if not treated quickly. Medicare will cover surgery to repair a detached retina, but youll be responsible for your Part B deductible and 20% coinsurance, which Medigap can help take care of. Depending on where you have your procedure, a copayment might apply as well. Similarly, Medicare Advantage will cover retina surgery to preserve vision, although your out-of-pocket costs will depend on your plan.

What Vision Care Is Covered By Medicare

Medicare Part B helps pay for these medically necessary vision-related services:

Cataract surgery if its done using lasers or traditional surgical techniques. This procedure replaces your cloudy lens, which is the source of your blurry vision, with a clear artificial lens called an intraocular lens .
Corrective lenses if you have cataract surgery either one pair of eyeglasses with standard frames or one set of contact lenses from a supplier who is enrolled in Medicare.
Glaucoma screening test once every 12 months if you are at risk for glaucoma, which is increased pressure within the eyeball that adversely impacts your sight over time. Risk factors for glaucoma are:

A family history of glaucoma
If you are African American and aged 50 or older
If you are Hispanic and aged 65 or older

Yearly eye exam for diabetic retinopathy if you have diabetes. Retinopathy is a disease of the retina, the back part of your eyeball that interacts with your optic nerve to form a visual image. This exam must be done by an eye doctor who is legally allowed to do the exam in your state. Treatments may include medications, laser treatments, and surgery.

If you have age-related macular degeneration , Part B may cover certain diagnostic tests and treatment of eye diseases and conditions. The macula is the small central portion of your retina, and as it wears down, it causes loss of vision. Treatment may include medications, laser treatments, and vision aids.

Don’t Miss: Is Medicare A Social Security Benefit

Does Any Medicare Plan Cover Annual Vision Check

Medicare Advantage, sometimes called Medicare Part C, is a form of add-on private insurance that is likely to cover routine annual eye exams specifically about prescription eyewear meant to correct vision. The glasses or contacts might also be covered, and the plan may include drug coverage.

There are many other benefits Medicare Advantage has that other forms of Medicare dont. Routine hearing care is often covered, for example. Dental care coverage is usually an option. You might also have access to wellness programs and discounted gym memberships. Nutrition and fitness are vital components of a healthy lifestyle, and its never too late to take a closer look at nutrition and fitness.

Original Medicare Part B Services

Seniors enrolled in Medicare Part B are not directly covered for routine eye exams, but Medicare Part B does pay for the cost of glaucoma screenings. This typically includes an eye exam, and so it is likely to uncover other, non-glaucoma conditions that can affect vision, such as astigmatism.

Medicare Part B beneficiaries are entitled to one free glaucoma screening a year if their doctor has diagnosed them as being at an elevated risk of the condition.

High-risk individuals typically include:

African-American beneficiaries over age 50

Hispanic or Mestizo beneficiaries over age 65

Part B beneficiaries may also qualify for an annual vision screening to check for diabetic retinopathy, provided they are:

Enrolled in Part B

Willing to schedule the exam with an optometrist in their own state

Finally, Medicare Part B also authorizes annual exams to check for macular degeneration, which is the most common cause of vision loss for American seniors over age 50. If the condition is diagnosed, then Medicare Part B pays 80% of the cost of treatment, such as certain IV drugs administered in an outpatient clinic, after a beneficiary meets their annual Part B deductible.

Medicare Vision Benefits Medicare Part A

Medicare Part A is hospital insurance. Medicare Part A covers vision care only when the vision condition is considered a medical problem â as in a medical emergency or traumatic injury when the beneficiary must be admitted to the hospital.Medicare Part A coverage does not cover routine vision exams and eye refractions. Beneficiaries must pay 100% of the cost unless they have other vision coverage.

Where Can I Learn More About Medicare And My Coverage Options

Eyecare is such an overlooked but important part of your medical care, and PolicyScout wants to ensure that you find the best coverage for your eyes.

If you are looking for up-to-date and accurate information about Medicare, Medicare Advantage, and Medicare Supplemental Insurance, head to PolicyScouts Medicare Hub to compare your options and find the best plan for you.

We can also connect you with some of the best Medicare Advantage providers in your area if youre ready to look into different Medicare Advantage plans.

If you are looking for more guidance, send your questions to or call us on to get personalized assistance from one of our skilled Medicare consultants.

Recommended Reading: Does Medicare Cover Prolia Injections

Do Medicare Advantage Plans Cover Eye Exams

Medicare Advantage plans are offered by private health insurance companies. They cover everything Original Medicare does but most provide additional benefits. For example, they may offer additional coverage for hearing exams, dental services, out-of-network care, or even fitness memberships.

Additionally, many MA plans cover routine vision services, including eye exams and reimbursement for eyeglasses or contact lenses. Contact your plan for more information.

What Eye Care Is Covered By Medicare

Eye On Health: Medicare Enrollment

Routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare covers: Surgical procedures to help repair the function of the eye due to chronic eye conditions.

How Does Medicare Cover Vision Services And Treatment

Q: Does Medicare cover hospice care? A: Hospice programs provide care and support people who are terminally ill. Their focus is on comfort, or palliative care, not on curing an illness, and Medicare covers most of the cost of this care.

Most American seniors have access to zero-cost testing for COVID-19 and fairly manageable out-of-pocket costs if they end up needing treatment for the disease. And supplemental coverage, including Medigap, Medicaid, or an employers plan, can reduce those out-of-pocket costs to very little or nothing.

For half a century, Medicare has provided comprehensive health insurance coverage to Americas seniors. But dental coverage isnt included in Original Medicare or Medigap plans.

Q: How does Medicare cover vision services and treatment?

A: Original Medicare wont pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions. Most Medicare Advantage plans do include coverage for routine vision services like eye exams and glasses or contacts. They will also cover treatment for eye diseases and conditions, although the out-of-pocket costs can vary considerably depending on the specific plan.

Is A Routine Eye Exam Covered By Medicare

Routine vision checks, annual eye exams, and eye tests for eyeglasses or contact lenses are generally not covered under Original Medicare .

However, Part B will cover routine eye exams and certain expenses if the procedure is deemed to be medically necessary health care services that a health care provider, using clinical judgment, would provide to a patient.

For example, if the patient has diabetes or is at risk for glaucoma they can go for an annual eye exam. Medicare Part B will also cover diagnostic tests and treatments for particular eye or vision diseases such as aflibercept, Lucentis, and ocular photodynamic therapy.

Part B will contribute toward one pair of corrective glasses or one set of contact lenses following cataract surgery to implant an intraocular lens.

Once the patient has paid the annual deductible , Part B will reimburse 80% of the Medicare-approved amount for the glasses.

You will only receive coverage if your treatment is approved and given by an eye expert who accepts Medicare. The remaining 20% will be paid by you.

Source: Pexels

Also Check: How Does Medicare D Work

Which Eye Exams Does Medicare Cover

In general, Original Medicare doesnt cover routine eye exams for eyeglasses or contact lenses however, there are some exceptions to this rule because Medicare can provide coverage for eye exams and vision care if an individual has diabetes, glaucoma, macular degeneration, or has undergone cataract surgery.

How Do I Join A Medicare Advantage Plan

You must have Medicare Part A and Part B before you can enroll in a Medicare Advantage plan. Some Medicare Advantage companies allow you to apply online, whereas others require you to submit a paper form. Even if you cant apply for a plan online, all plans are required to give you the option of a paper form.

If you do not sign up for a Medicare Advantage plan in your initial enrollment period , you can sign up during a special enrollment period or fall open enrollment period.

Be wary of being solicited for a Medicare Advantage plan. Medicare Advantage companies never call you without you first specifically asking to be called. Additionally, they never ask for financial information over the phone. If you receive an unsolicited call or home visit offering a Medicare Advantage plan, it is a scam that you can report to 1-800-MEDICARE.

Don’t Miss: How Much Does Medicare Cost Each Month

Are Vision Exams Covered Under Medicare

What Does and Doesnt Medicare Cover?

Have you had a hard time reading the grocery list lately? Does your phone screen look a little blurry when you send a text message? It might be time for a vision exam and some new glasses.

Vision changes are a normal part of aging and certainly an important part of your health. But after you retire, whats the best way to pay for vision exams and glasses? Unfortunately, Medicare may not be the answer.

Lets walk through the essential details you should know about Medicare and vision coverage.

Does Medicare Cover Eye Surgery

Although Medicare doesnt cover vision, hearing, or dental procedures, there are certain exceptions. For instance, if you require eye surgery or have a chronic eye condition that puts you at high risk, Medicare can cover cataract surgery or exams for high-risk patients with diabetes.

Medicare can cover cataract surgery with the exception that its done using traditional surgical techniques or lasers. Medicare would be able to cover 80 percent of the cost of medically necessary cataract surgery after the deductible is met. Additionally, Medicare Part B can help pay for corrective lenses after youve undergone cataract surgery to implant an intraocular lens. If the procedure is deemed medically necessary, the corrective lenses would be covered by Medicare.