Does Medicare Cover Eye Specialists

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 Require A Referral To See A Specialist

Although a primary care doctor can help you navigate many of your healthcare needs, you may have medical conditions that require the care of a specialist. Understanding when a specialist should be consulted and whether or not your Medicare benefits provider requires a referral beforehand can help you streamline your access to care.

Determining When to See a Specialist

The function of a primary care physician is to help you establish health needs and then help you maintain common health goals and preventive care. An appointment with your primary care doctor is typically your first step in addressing any chronic or acute symptoms.

While they may offer an initial diagnosis or order certain tests to confirm or rule out any medical condition, they are not always trained or experienced to address more complex health needs. In those situations, your primary care doctor will refer you to a specialist.

According to the Association of American Medical Colleges , there are over 120 specialty and subspecialty branches of medical practice. Their focus can be targeted on a disease or group of diseases, a specific organ or system of organs within the body. Depending on your medical needs, you may be referred to more than one specialist as a treatment plan is developed.

Original Medicare Referral Requirements

Medicare Advantage Plan Referral Requirements

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Medicares Coverage Of Cataract Surgery And Other Vision Benefits

Most people are surprised when they turn 65 to find out that Medicare has fairly limited benefits for vision services. After all, our vision often worsens as we age, so we generally need more vision care as an older adult.

While Medicare doesnt cover routine vision services, it does offer benefits for a variety of injuries or illnesses related to optic health.

Heres what you can expect for vision coverage once you enroll in Medicare.

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Medicare Advantage And Vision Coverage

If you want a Medicare-based plan that offers vision coverage, Medicare Advantage is one option to consider.

With a Medicare Advantage plan, you are entitled to all of the benefits covered under Original Medicare , but they are provided by private insurance companies instead.

This allows you to choose a policy that offers vision coverage in addition to the typical Medicare coverages. You may pay a bit more for it, but it may be cheaper than paying your own expenses toward exams, eyeglasses, and contacts on an annual basis.

Do not confuse Medicare Advantage with Medigap insurance. Medigap doesnt typically offer vision care or eyeglass benefits, but it can be used to help cover costs associated with copayments, coinsurance, and deductibles.

Medicare vision coverage is limited, but it does provide benefits in some cases. Its important to always check with your individual plan to know for sure what your policy will pay and what amount youll be responsible for.

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Am I Eligible For Vision Care Through Unitedhealthcare

To be eligible for a UnitedHealthcare Medicare Advantage plan with vision coverage, you must be enrolled in Medicare Part A and Part B.

UnitedHealthcares vision coverage is elective immediately, meaning there is no waiting period to use the coverage.

Medicare Advantage plans often come in the form of HMO or PPO plans, which means your plan may feature a network of preferred eye doctors and vision care centers.

UnitedHealthcare has a large network of eye doctors all over the U.S. who accept the companys vision insurance. To find an eye care provider near you who accepts UnitedHealthcare vision insurance, you can enter your ZIP code into the UnitedHealthcare Find a Doctor search tool.

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Does Medicare Cover Eyeglasses Or Contact Lenses

Original Medicare does not cover eyeglasses or contact lenses without a stand-alone vision plan or Medicare Advantage, you pay 100% of the costs.8

Cataract surgery

Cataract surgery treats a condition that makes the lens in your eye cloudy and can affect your vision. If you have cataract surgery, Part B will pay for your eyeglasses or contact lenses following that surgery.

Part B will only pay for specific frames9 from a Medicare-approved provider.10 You pay more if you choose upgraded frames.

What Do Eye Exams Cost With Medicare

As mentioned, Medicare generally doesnt cover routine eye exams, but there are exceptions for high-risk patients.

The average cost of eye exams without insurance ranges between $50-$70. Most insurance policies dont usually cover routine eye exams and might have additional copays. Since routine eye exams are generally not covered by Medicare, youd pay 100 percent of their cost.

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Mandy Medicare Advantage Plans Also Cover Vision Care

Medicare Advantage plans are sold by private insurers and provide the same hospital and medical benefits as Medicare Part A and Part B .

In addition to these standard benefits, some Medicare Advantage plans also cover vision, dental and prescription drug coverage, which are not typically covered by Original Medicare.

If your vision is impaired due to blepharoptosis or another condition and requires the care of an ophthalmologist, a Medicare Advantage plan that covers vision may help cover some of the costs associated with your routine eye care.

Keep in mind, your plan will likely not cover eyelid surgery if the need for it is strictly cosmetic.

Specific benefits and costs will depend on the Medicare Advantage plan in which you enroll, but there may be $0 premium plans in your area.

Find a Medicare Advantage plan that covers eyelid surgery

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

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.

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Does Medicare Cover Vision

Home / FAQs / Medicare Coverage / Does Medicare Cover Vision

Medicare routine vision coverage isnt comprehensive but, there is coverage for severe eye conditions. Your eyes work hard for you, and they deserve high-quality care, but is it even possible with Medicare? In this article, we go over all the costs, coverage, and benefits of vision care. Its essential to make sure you have everything you need in retirement glasses might be part of that.

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Will Medicare Cover Treatment For Eye Injuries

Like excessive dryness, eye injuries arent considered routine, and are therefore eligible for coverage under Medicare, subject to the usual 20% coinsurance and deductible that Medigap can help with. Medicare Advantage will cover treatment for eye trauma as well, although out-of-pocket costs will depend on the plans benefit structure.

Does Medicare Cover Eyelid Surgery

Eyelid surgery may be covered by Medicare if it is considered medically necessary and reconstructive .

Medicare Advantage plans cover eyelid surgery if it is considered medically necessary by your doctor, and they also offer an annual out-of-pocket spending limit, which Medicare Part A and Part B do not offer.

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Eye Care Services Covered By Original Medicare

Even though routine vision check-ups, eyeglasses, and contact lenses are not covered by Medicare, there are vision-related surgeries and care that will likely be covered by Medicare. For instance, conventional intraocular lenses implanted in the course of cataract surgery would be covered. In this case, the lenses must be inserted by an ophthalmologist while the surgery is taking place. The IOL replaces the eyes crystalline lens, which becomes cloudy or opaque when someone has cataracts.

Glaucoma screening, if covered, is subject to a deductible and co-payments/coinsurance. The coverage is contingent upon the beneficiary being high-risk. For a Medicare recipient to be considered high risk, they may suffer from diabetes, have a family history of glaucoma, are African-American and 50 years old or more, or are Hispanic-American and 65 years old or more. This glaucoma screening can be performed by an optometrist or ophthalmologist.

When Medicare Covers Eye ExamsOther eye-related services may be covered under specific circumstances. As a result of a birth defect, traumatic incident or surgery, some people have eye prostheses. Medicare benefits in this case would include five-year replacements, polishing and resurfacing.

How Can I Book An Appointment Online With A Medicare Eye Doctor

Zocdoc is a free online service that helps patients find Medicare Eye Doctors and book appointments instantly. You can search for Medicare Eye Doctors by symptom or visit reason. Then, choose your location. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.

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How Can I Find The Best Ophthalmologist Near Me

If youre looking for the best Medicare ophthalmologists near you, youll have to do a little research. You can use the Medicare website to find providers in your area.

Once you find Medicare ophthalmologists near you, its a good idea to look at the reviews. If you need an ophthalmologist with Medicare, theres a good chance you have a serious eye problem. Therefore, you want the best doctor around.

If you have a Medicare Advantage plan, youll be able to find an eye doctor in your area easily. Still, you will need to make sure they are in-network and check reviews.

Taking Eye Care To A Higher Level

Some optometry practices go the extra mile and take a proactive approach to eye care. These practices will have invested in the test imaging and diagnostic technology. Their optometrists will be therapeutically qualified. This means they can not only diagnose your eye condition, but also treat it. The highest level of training involves regular travel overseas for continuing education. This isnt available in Australia.

The Eye Practice provides , peripheral vision testing, intra-ocular pressure and corneal thickness measurements on all patients. If indicated, a map of your cornea is also taken, so that cornea disease can be properly diagnosed, managed and monitored.

If you have a particular problem such as dry eyes or red eyes, you may need more tests. These will help identify the source of the problem. Questionnaires on your medical history and ocular symptoms will also shed light on what may be causing your eye problem.

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Does Medicare Cover Lasik Surgery

Part A and B wont pay for Lasik procedures unless theyre necessary, and that is rare. One example is a traumatic injury in which Lasik could benefit. Lasik is a procedure that treats farsightedness, astigmatisms, and nearsightedness in the eyes.

Lasik surgery is the most common eye surgery and has proven to improve eyesight, immediately following the procedure drastically. Its a surgery that uses a laser and is virtually pain-free for patients. Most times, Medicare will not pay for the eye exam given before a Lasik procedure.

Medicare Coverage Of Surgery To Correct Cataracts

Talk to your doctor if you think you have cataracts. Medicare doesnt cover routine vision exams, but Medicare Part B does cover certain preventive and diagnostic eye exams. Ask your doctor if a diagnostic exam to check for cataracts would be covered by Medicare.

Some important things to know:

• If youre getting the procedure as an outpatient, Medicare Part B covers the fees for the surgeon, the facility, the anesthesia, and the surgery both to remove the damaged natural lens with the cataracts and to replace it with an artificial, intraocular lens. Youll pay the normal Medicare Part B cost sharing, which may include your Medicare deductible, and/or 20% of the amount approved by Medicare after you have reached your deductible. Medicare pays for any follow-up care after your cataracts are removed, subject to the Medicare coinsurance and deductible.

• Medicare also pays for lenses and frames for one pair of glasses or contacts that your doctor prescribes after your cataracts are removed and an intraocular lens is inserted. You must get these glasses or contacts through a Medicare-approved supplier. Medicare covers the cost of lenses for both eyes , even if the cataracts were only removed in one eye.

• Please note that Medicare will only pay for standard frames. If youre uncertain as to which frames are Medicare eligible, ask your doctor or health-care provider for a list of eligible frames to avoid extra costs.

World Health Organization, Priority eye diseases.

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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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When Does Medicare Cover Blepharoplasty

Typically, for eyelid surgery to be considered medically necessary, it must be for reconstructive purposes, such as:1

• You have drooping eyelids that causes visual impairment
• A trauma or another eye surgery caused defects to your eyelid
• You have painful symptoms due to abnormal contraction of the eyelid muscles
• You experience eyelid complications due to thyroid disease and nerve palsy

Be sure to check with your doctor before receiving services to see if your eyelid surgery will be covered by Medicare.

If your vision is not impaired, eyelid surgery is considered cosmetic and will not be covered by Medicare.

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Find A Unitedhealthcare Medicare Plan With Vision Coverage

Because Original Medicare does not provide vision coverage, Medicare beneficiaries may want to consider joining a UnitedHealthcare Medicare Advantage plan that offers vision coverage.

To learn about the vision coverage included in any UnitedHealthcare Medicare plans that are available in your area, speak with a licensed insurance agent by calling 1-855-580-1854TTY Users: 711 24 hours a day, 7 days a week.

1 As of Mar. 31, 2021. UnitedHealth Group. UnitedHealth Group Reports First Quarter Performance . https://www.unitedhealthgroup.com/viewer.html?file=/content/dam/UHG/PDF/investors/2021/UNH-Q1-2021-Release.pdf.

2 According to internal data from TZ Insurance Solutions in 2020.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

A Private Fee- for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plans contract renewal with Medicare.

You must continue to pay your Medicare Part B premium.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.

Glasses Contacts And Eye Exams: Does Medicare Cover It

In your 60s and beyond, eye conditions like cataracts, diabetic retinopathy, glaucoma, and age-related macular degeneration are extremely common, with some conditions occurring in more than half of seniors.

Once you turn 65, youâre probably relying on Medicare coverage to help with vision expenses. We turned to Dr. Bradley Grant, O.D. at Mid-State Eye in Central IL for some insight into how Medicare helps pay for things like glasses, contacts, eye exams, and common treatments.

Need Medicare or retirement planning help? The Sams/Hockaday team specializes in Medicare health insurance as well as retirement planning. Read more about what we do and schedule an appointment with the agent of your choice today!

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