Saturday, April 13, 2024

What Eye Care Does Medicare Cover

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Eyeglasses And Contact Lenses

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Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, Medicare Part B helps pay for corrective lenses .

Note: Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim .

All people with Part B are covered. Your costs in Original Medicare are:

  • You pay 20% of the Medicare-approved amount for one pair of eyeglasses or one set of contact lenses after each cataract surgery with an intraocular lens.
  • Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter who submits the claim .
  • You pay any additional costs for upgraded frames.
  • You pay 100% for non-covered services, including most eyeglasses or contact lenses. The Part B deductible applies.

Note: Some Medicare Advantage plans offer extra vision benefits. Be sure to contact the plan for more information.

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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Will Medicare Cover Your Eyes Exams

Potential eye problems can be avoided with timely eye exams, especially as people grow older. The chances of developing glaucoma, cataracts, and other vision problems tend to be higher with older people, which is why older adults need to understand what Medicare plans will pay for eye exams.

In general, Original Medicare, which includes Part A and Part B, does not cover routine eye care services, such as regular eye exams, vision tests, or eye refraction tests for contact lenses and eyeglasses.

In other words, you will pay 100% for eye exams for contact lenses and eyeglasses if you have Original Medicare.

However, Medicare may cover some vision care services, especially for people with chronic eye conditions. Here are some of the eye exams that may be covered:

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Does Blue Cross Blue Shield Cover Cataract Surgery

  • Blue Cross Blue Shield Medicare Advantage plans cover cataract surgery, as its covered by Original Medicare . Learn about the other vision benefits some BCBS Medicare plans may offer, how much cataract surgery costs with Medicare and more.

Cataract surgery can cost between $3,500 and $7,000 per eye, which should beg the question of whether its covered by insurance.

Blue Cross Blue Shield Medicare Advantage plans typically cover cataract surgery when its considered to be medically necessary treatment. Medicare Advantage plans are required to cover the same benefits that are covered by Original Medicare .

Because cataract surgery is covered by Original Medicare when performed using traditional surgical methods or with the use of lasers, all Medicare Advantage plans, like the ones from Blue Cross Blue Shield, at least cover the same type of surgery. Some plans may cover even more routine vision care costs than Original Medicare, such as prescription glasses, contacts, eye exams and more.

Blue Cross Blue Shield affiliate companies can vary by state, so its best to compare plans online or call to speak with a licensed insurance agent to find the specific plan benefits available where you live.

What You Pay For Home Health Services

What Does Medicare Cover

All eligible Medicare recipients pay the following for home health services:6

  • $0 for home health services
  • 20% of the Medicare-approved amount for like a walker, wheelchair or hospital bed

Before home health care begins, your home health agency should explain your bill. This includes what Medicare will help cover, what Medicare wont cover and how much youll owe . The details of what isnt covered by Medicare must be given to you in an before you receive any uncovered items or services.7

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How Much Is Cataract Surgery With Insurance

As a general example, a standard cataract surgery in a clinic or surgery center may cost about $3,500. A patient with Medicare insurance coverage will be responsible for $700 . The total out-of-pocket cost will also include the deductible amount, which depends on the patientâs specific insurance plan.

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Other Options For Routine Vision Care

If you enroll in Original Medicare or a Medicare Advantage plan without vision care benefits, you may still be able to get eye exam coverage. Many large insurance companies sell stand-alone vision, dental, and hearing policies you can combine with your Medicare coverage. If you buy a Medicare Advantage or Medicare Supplement plan, ask your insurer if they offer a separate vision care plan.

If you have a health savings account , you can take qualified withdrawals to pay for eye exams and glasses. If youre age 65 or over, you can even pay your vision insurance premium with HSA funds.

Even though Medicare vision coverage is limited, you still have options to help pay for eye exams and glasses. Compare Medicare Advantage plans in your area and check the costs of stand-alone vision plans. With so many options, youll certainly be able to find the right coverage to suit your individual health goals and financial needs.

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Determining Cataract Surgery Cost

Since most people who undergo cataract surgery in the U.S. have Medicare or private medical insurance, it can be somewhat challenging to determine the cost of the procedure for someone with no insurance coverage.

In such cases, many surgeons often charge the same fees for cataract surgery that they charge for an elective vision correction procedure called refractive lens exchange .

Refractive lens exchange is essentially the same procedure as cataract surgery, but the eyeâs natural lens that is removed in RLE has not yet become clouded by a cataract. By replacing the eyeâs natural lens with an IOL, the surgeon can correct significant amounts of nearsightedness or farsightedness, reducing the patientâs need for eyeglasses or contact lenses.

In 2019, the average cost of refractive lens exchange with a standard monofocal IOL implant was $3,783 per eye, according to a large survey of U.S. cataract and refractive surgeons.

For RLE with a toric IOL for astigmatism, the average cost was $5,304 per eye, and the average cost of RLE with a presbyopia-correcting IOL ranged from $4,704 to $6,898 per eye.

How Can I Find The Best Ophthalmologist Near Me

Medicare & You: Glaucoma

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.

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Cataract Surgery And Medicare

Now that you know a little more about Medicare and cataracts that dont require surgery, lets take a look at surgical options.

Cataract surgery is a simple procedure that involves replacing the natural lens in the affected eye with an artificial one. If you have cataracts in both eyes, youll likely have it performed on one eye at a time.

Since cataract surgery is typically performed on an outpatient basis, its covered under your Medicare Part B benefits. Medicare Part B also covers:

  • Eye exams to diagnose serious vision problems
  • Pre-surgery eye exams

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What Does Medicare Part C Cover

Medicare Part C is also known as Medicare Advantage. Medicare Advantage plans are provided by private companies with approval from Medicare. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Many Medicare Advantage plans also provide prescription drug coverage .5

Original Medicare Costs Associated With Vision

Does Humana Medicare Advantage Cover Cataract Surgery ~ ziyydesign

In all of these situationsthe diabetic exams, glaucoma tests, and macular degeneration teststhe costs passed on to the participants is the same.

Medicare Part B recipients can expect to pay 20 percent of the Medicare-approved amount for that particular exam or test.

Any deductible you may have under Part B applies as well.

If the exam is conducted in a hospital outpatient setting, which means that it is needed as a result of an emergency service or prior to surgery, you may have to pay a copayment. The amount of this copayment is dictated by your individual plan.

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The Bottom Line: What Does Medicare Cover For You

Know your options. Do your homework. Take some time to understand your Medicare plan.

Remember that are required by law to offer all the benefits of Original Medicare, but most plans offer much more.

Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs.

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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 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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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.

Does Medicare Advantage Pay For Eye Exams And Glasses

Eye On Health: Medicare Enrollment

Medicare Advantage is private insurance coverage, which means that its an alternative way to get your Medicare benefits. By law, it has to cover everything Original Medicare covers. At a minimum, Medicare Advantage covers eye exams whenever theyre covered by Original Medicare.

Most Medicare Advantage plans do include extra benefits such as routine vision and dental care. Since Medicare Advantage plans compete for new members, its in their business interest to offer extra benefits that are important to Medicare beneficiaries.

Because routine eye care isnt a standard Medicare benefit, plans can structure their vision coverage in different ways. Some pay the full cost of annual eye exams with network providers, others pay a flat amount toward care with any provider, and others offer discounts on eye exams and eyewear. Check the plan brochures to compare benefits.

You can use the Medicare Plan Finder to search for Medicare Advantage plans with vision coverage in your area. Medicare brokers are another good resource for information about local plans and provider networks.

Keep in mind that plans often change their benefits, so a plan with eye exam coverage this year may have different benefits next year. Be sure to read your Annual Notice of Change each fall so you know what to expect.

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What If I Need Vision Care That Medicare Does Not Cover

If you need care that your Medicare plan does not cover, the National Eye Institute website has a list of helpful resources. Visit the institute’s Get Help Paying for Eye Care page for more information.

You also may want to consider a private vision plan or discount program. Private plans often offer benefit levels ranging from routine to specialty care, so you can tailor coverage to meet your needs. When reviewing plans, watch for coverage limits, network restrictions and out-of-pocket expenses like deductibles and copays.

Does Medicare Pay For Glasses Or Contacts

Medicare doesnât typically cover the cost for eyeglasses or contact lenses, and youâll normally have to pay the full cost for these items, as well as exams to get fitted for them. However, if you get cataract surgery to insert an intraocular lens, Medicare Part B covers corrective lenses following your surgery. Youâre covered for either one pair of glasses or contact lenses if you get these items through a supplier that is enrolled in the Medicare program.

All beneficiaries with Medicare Part B are covered, and youâll pay 20% of the Medicare-approved cost for the eyeglasses or contact lenses . If you decide to upgrade your frames, youâll pay for any extra costs.

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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 Can I Find Eye Doctors Near Me

Does Medicare Cover Eyeglasses and Vision Care? â

To find eye doctors or specialists near you that accept Medicare, you can use our plan finder tool. Simply type in your zip code and find plans that include vision care services.

Along with visiting your ophthalmologist or optometrist regularly, you can protect your eyes by doing the following:

  • Wearing good quality sunglasses when youre outside
  • Quitting smoking or using other tobacco products
  • Eating a healthy diet full of nutrients from fresh fruit and vegetables
  • Engaging in physical activity every day
  • Keeping your blood pressure at a healthy level
  • Managing blood sugar levels
  • Avoiding eye strain from too much screen time

Protecting your vision is vital to staying independent and healthy in your senior years, so its important to have information about how your Medicare insurance covers vision care services and how to find eye doctors who accept Medicare near you.

TIP: Use the Medicare plan finder to help you find out which plans offer the best vision services and compare them against your existing coverage.

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Will Medicaid Cover Eye Care Then

Medicaid has stringent rules on what your total household income can be for you to qualify to receive Medicaid benefits. But, if you meet their criteria, you and your family can receive eye care, including routine eye exams and more. Medicaid covers comprehensive eye exams and basic eye exams, which could include procedures such as pupil dilation, glaucoma checks, color blindness checks, and many more preventative exams.

If you qualify, Medicaid also covers eyeglasses which include lenses, fittings, and frames. Repairs and replacements of glasses are offered as well.

What Is Medicare Coverage For Eyeglasses

As we already mentioned, Part A and Part B of Original Medicare do not cover the cost of glasses or contact lenses. Unfortunately, retirees should pay out of pocket for them.

However, Medicare Advantage plans often cover the cost of glasses or contact lenses. If you are enrolled in a Medicare Advantage plan, you should check with your plan provider to see available coverage. When you are not enrolled in a Medicare Advantage plan, there are some other options available to help cover the cost of glasses or contact lenses. For example, some private insurance plans offer vision coverage, and you can also purchase a standalone vision plan to help cover the costs.

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Does Medicare Cover Medical Devices

Medicare Part B helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Your copays and deductibles will still apply.

There is a long list of items covered, including:

  • Continuous Glucose Monitors examples include Dexcom and Libre
  • Insulin pumps and supplies
  • Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. Medicare will only provide coverage through suppliers who participate in the Medicare program.10

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