Thursday, September 29, 2022

Does Medicare Cover Eye Exams For Glaucoma

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Original Medicare Medicare Advantage And Vision Coverage

Medicare & You: Glaucoma

Original Medicare Medicare Part A and Part B does not cover most vision services. There are a few exceptions.

Vision Services Covered by Original Medicare

  • Glaucoma tests once a year if you are at high risk for glaucoma
  • Tests once a year for diabetic retinopathy if you have diabetes
  • Certain tests and treatment for age-related macular degeneration

For the most part, Original Medicare will not cover routine eye exams for glasses or contact lenses.

Medicare Advantage plans are required to cover everything Original Medicare covers. But these plans may have additional benefits, including vision coverage.

When choosing a Medicare Advantage plan, you should make sure it includes vision coverage if thats important to you.

Medicare Vision Coverage And Medicare Advantage Plans

Medicare Advantage plans are an alternative to the government-run Medicare program and provide another way to get your Original Medicare, Part A and Part B, benefits. Offered through private insurance companies that are contracted with Medicare, these plans are required to cover at least the same level of benefits as Medicare Part A and Part B .

However, one benefit of Medicare Advantage plans is that they may offer coverage that goes beyond Original Medicare, including routine vision or dental, hearing, and prescription drugs. Benefits vary by plan, but Medicare Advantage plans may cover routine eye exams, eyeglasses, contacts, and fittings for frames and contact lenses this coverage would be in addition to all of the preventive or diagnostic vision services and treatment covered under Original Medicare. Since each Medicare Advantage plan may offer different coverage, always check with the individual plan to see if vision benefits are included and what your costs may be. You still need to continue paying your Medicare Part B premium if you sign up for a Medicare Advantage plan, in addition to any premium the plan may charge.

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What Are Glaucoma Screenings

Glaucoma is the leading cause of blindness in people over 60. It occurs when fluid builds up in the front part of the eye. The fluid increases pressure and damages the optic nerve.

It can be prevented, but requires routine glaucoma screenings to detect it early, according to the American Academy of Ophthalmology.

A comprehensive glaucoma screening typically requires five types of tests measuring different factors that may indicate whether you have glaucoma, according to the Glaucoma Research Foundation.

Tests Used in a Comprehensive Glaucoma Examination

Regular eye exams feature just two of these tests: tonometry and ophthalmoscopy. But you may need to take a more comprehensive examination featuring more or all of these glaucoma tests.

Glaucoma is often difficult to diagnose and the tests can zero in on an accurate diagnosis. But you still may be referred to a glaucoma specialist if your examining doctor cant gather enough information to make a diagnosis.

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Are There Other Options To Get Medicare Coverage For Eye Exam Costs

You may be able to enroll in a Medicare Advantage plan that offers coverage for routine eye exam costs and even prescription eyewear. The Medicare Advantage program is an alternative way to get your Original Medicare benefits. These plans must provide the same coverage as Part A and Part B .

Many Medicare Advantage plans include coverage for prescription drugs, as well as other benefits to help you manage your health-care costs, such as:

  • Benefits for routine vision care, including an annual eye exam and prescription eyewear
  • Coverage for routine hearing care
  • Optional dental care coverage for routine exams, cleanings, and even restorations and dentures
  • Benefits for wellness programs and discounted gym memberships

Not all Medicare Advantage plans have all these optional benefits and coverage, and not all plans may be available in all areas. You must continue to pay your Part B premium, plus any additional premium required by your plan, and premiums may vary depending on the plan you choose and where you live. You will also be responsible for any copayments, coinsurance amounts, or deductibles required by your plan.

Request an email or schedule a telephone call by using one of the links at the bottom of the page. To see a list of plans in your area you may qualify for, click the Compare Plans button on this page.

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Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

Will Medicare Pay For Treatment For A Detached Retina

Medicare and glaucoma testing: Coverage, options, and costs

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.

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Medicare Vision Benefits Medicare Part C

Medicare Part C offers an alternative way to receive your Original Medicare benefits. Medicare Advantage plans are offered by private, Medicare-approved insurers. All private insurers must offer at least the same benefits as Original Medicare , but they may include other benefits, such as routine vision, routine dental, and Medicare prescription drug coverage. When routine vision benefits are available through a Medicare Advantage plan, your premiums could be higher than those charged by Medicare Advantage plans that do not offer routine vision benefits.

Some Medicare Advantage plans include full coverage for routine vision exams, vision correction products, and other vision care. Review the specific Medicare Advantage plans vision benefits to be sure.

Routine Eye Exams Are Important As You Age

The risk of developing serious vision problems including macular degeneration, cataracts, and glaucoma increases as Americans grow older. The National Eye Institute recommends regular comprehensive dilated eye exams for adults age 50 and older.

While some groups of people, including those with diabetes or a family history of eye disease, are considered higher risk for developing eye disease than others, vision problems are not always the result of genetics or symptoms of a separate medical condition. Some common eye issues can be resolved or prevented with regular care, and routine eye exams are an important part of health maintenance for most seniors.

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Medicare Coverage For Diabetic Eyecare

If you have diabetes, some eyecare may be covered by Part B. Specifically, eye exams for diabetic retinopathy are covered once per year.

However, eyeglasses are not covered unless youve had a vitrectomy or cataract surgery, in which case Part B would cover the cost of one pair of glasses or contact lenses.

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How Often Can You Have An Eye Test With Medicare

Open Angle Glaucoma – An Explanation

Neither original Medicare nor Medicare supplement plans pay for routine eye exams, eye glasses, or contacts.

But Medicare offers some benefits if you are diagnosed with diabetes, have high eye pressure and are at risk for developing glaucoma, or if you have cataracts and need surgery. Prevent Blindness, a nonprofit advocacy organization, spells out the benefits. Here are some highlights:

Whether you have traditional Medicare or Medicare Advantage, your first step upon enrolling is to have your Welcome to Medicare preventive visit in your first 12 months of having Part B coverage. There should be no cost to you unless the healthcare provider runs extra tests or performs additional services. Youll get a basic visual acuity screening as part of the visit, and youll want to ask about a plan for eye exams then. After that, your free Medicare annual wellness visit can help you keep track of your preventive care.

Diabetes: If you have diabetes, Medicare will pay 80% of the cost of an annual glaucoma screening and comprehensive eye exam that can also detect diabetes-related retinopathy. If you need more than one exam a year, youll have to pay for it.

Age-related macular degeneration: If you have an eye exam and it shows that you have AMD, Medicare will pay 80% of the cost of the test and then the cost of annual tests, plus the cost of treatment. You must pay for more frequent tests.

Glaucoma:Medicare will pay for a glaucoma test annually if one of the following applies to you:

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When Might Medicare Cover Eye Exams

While Original Medicare doesnt generally cover routine eye care, there are a few instances when your Part B coverage may help offset your eye exam costs:

  • If you are considered to be at high risk for glaucoma , Part B may cover 80% of allowable costs if your doctor believes the test is medically necessary.
  • If you have diabetes, Part B may cover 80% of your eye exam cost to check for diabetic retinopathy.
  • Certain people with age-related macular degeneration may qualify for Part B coverage of eye exams and treatment, including injectable medications, for the disease.
  • If your eye gets injured, Original Medicare may cover medically necessary diagnostic eye exams and treatment.

You must get care from a provider who accepts Medicare assignment in order to be covered. Youll generally also pay 20% of allowable charges plus any applicable Part B deductible.

Does Medicare Cover Diabetic Retinopathy

Diabetic retinopathy can damage blood vessels in the eye, causing vision problems and loss. If youve been diagnosed with diabetes, Medicare Part B will pay for one eye exam per year to get ahead of brewing eye problems. Youll still pay 20% of the Medicare-approved amount for your exam, and your Part B deductible will apply if you havent met it yet.

Treatment is often addressed at targeting the underlying condition diabetes and Medicare will provide coverage for the medical care necessary to treat diabetes. An insulin savings program is being tested on various Part D plans starting in 2021, and enrollees in these plans can get insulin for no more than $35/month.

As is the case for other services, a Medigap plan can pick up some or all of the cost of the Part B deductible and coinsurance related to diabetic retinopathy testing, depending on the Medigap plan you have. And if you have a Medicare Advantage plan, your costs will depend on the plans benefit structure.

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Welcome To Medicare Physical

The Welcome to Medicare Physical is an initial preventive physical examination. Medicare will cover this examination only if it occurs within the first 12 months that a beneficiary has Part B coverage. During this Welcome to Medicare physical examination, your doctor will:

  • Record and evaluate your medical and family history, current health conditions, and prescriptions
  • Review your risk factors for depression and other mood disorders
  • Review your functional ability and level of safety
  • Check your blood pressure, visual acuity, weight, and height to get a baseline for your care
  • Discuss end-of-life planning agreements
  • Make sure youre up-to-date with preventive screenings and services, such as cancer screenings and vaccinations
  • Order further tests, depending on your general health and medical history
  • Following the visit, your doctor will give you a plan or checklist with screenings and preventive services that you need. Ask about eye exams!

Does Medicare Cover Glaucoma Surgery

Are Diabetic Eye Exams Covered By Medicare

As people get older, they can start to experience health problems that they never had before. One common issue among seniors is glaucoma, a condition that leads to vision loss over time if left untreated. If youre a senior citizen with glaucoma, then you may be wondering if Medicare covers your surgery.

Original Medicare andMedicare Advantage will cover glaucoma. Medicare considers glaucoma to be a medical condition. In general, Medicare will cover what a doctor deems medically necessary. Medicare doesnt cover routine vision. Exams, glasses, contacts are considered routine vision.

Well take a closer look at whether or not Medicare covers glaucoma surgery and what you need to do to make sure youre covered. Well also highlight some of the benefits of glaucoma surgery and answer some frequently asked questions about this procedure. So if youre wondering whether or not Medicare will help you pay for your glaucoma surgery, read on!

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Fact #: You May Be Able To Get Tested For Glaucoma With Medicare

Original Medicare covers glaucoma screening in high-risk people, including if you have diabetes, a family history of glaucoma, are African American and age 50 or older, or are Hispanic and age 65 or older. Medicare Advantage plans cover glaucoma testing too, but its a good idea to check with your insurance to see if its available. Most Medicare Advantage plans do include additional benefits for things like vision and dental, says Silas Jessup, an executive sales leader and licensed insurance agent for Northern Indiana and Western Michigan.

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What Does Medicare Cover

So, just what does Medicare cover when it comes to eye care? Generally, Medicare will cover exams and procedures that are medically necessary. If the exam or procedure prevents or treats a particular type of eye disease, it will likely be covered. However, if the visit is for corrective lenses only, then it will probably not be covered. Here are the details you need to know.

Fact #: Your Eye Doctor Can Treat Glaucoma Despite There Being No Cure For It

Eye On Health: Medicare Enrollment

Glaucoma is a chronic disease, which means there is no cure for it. Any vision loss it causes cannot be reversed. Fortunately, glaucoma can be controlled in most cases with medication or surgery.

The goal of treatment is to reduce the pressure of excess fluids in the eye that can damage your optic nerves. Depending on how serious your glaucoma is, your optometrist might order prescription eyedrops or refer you to an ophthalmologist for surgery. Surgery can be a treatment option to help improve drainage.

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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.

How Much Will Medicare Pay For Your Glaucoma Screening

Medicare will pay 80 percent of the cost once you have met your Medicare Part B deductible. You will have to pay 20 percent of the Medicare-approved amount for the screening.

If the screening takes place in a hospital outpatient facility, you will also have to pay a copayment.

Costs for glaucoma tests vary by doctor and depend on the type and number of tests a doctor may perform. You should talk with your doctor or other health care provider before the test to find out how much it will cost and whether Medicare will cover a portion of the screening.

Factors That May Affect Medicare Coverage of Glaucoma Screenings

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Find A Medicare Advantage Plan That Covers Dental And Vision Care

Medicare Advantage plans can come in a variety of types, such as HMOs or PPOs.

The type of plan you have may affect which dental or vision providers you can visit in your plan network. Before enrolling in a plan, its wise to check the plans network participants to see if your favorite dentist or optometrist accepts the plan.

Compare Medicare Advantage plans in your area

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

1 Fugelsten Biniek, J. et al. . Medicare Advantage 2021 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2021-spotlight-first-look.

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where youve seen coverage of Christians research and reports:

Which Medicare Plans Are Best If You Need Vision Care

Does Medicare Cover Eye Exams?

Medicare Advantage plans are best if you need vision care. MA plans cover all services that Original Medicare Part B does, plus help with routine eye exams and corrective lenses. According to the Kaiser Family Foundation, 91% of Medicare Advantage plans available in the U.S. in 2021 offer some vision benefits. You generally must choose in-network providers and may need to obtain referrals and prior authorization.

Details about vision care benefits you can receive and how much you pay are outlined in each plans Evidence of Coverage document.

Here is a comparison chart of five MA insurance companies, all HMO plans, to give you an idea of what non-Medicare vision coverage may be available to you in your area :

Medicare Advantage Plan Provider
CVS Health/Aetna Routine exams covered $150 reimbursement allowance for lenses. Can see any provider who accepts Medicare assignment

You can search for plans on the Medicare website. If you anticipate the need for vision care and corrective lenses, its a good idea to check with your eye care provider to see if they are in-network with the plan you choose.

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