Does Medicare Cover Eyeglasses – What eye exams does Medicare cover? What parts of Medicare cover eye exams? How much do eye exams cost with Medicare? Does Medicare cover vision services? Does Medicare cover glasses? Does Medicare cover eye surgery? Eye doctors who accept Medicare
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Does Medicare Cover Eyeglasses
Although Medicare does not offer comprehensive vision insurance, it may provide coverage for medically necessary vision insurance, often for patients with certain conditions, such as diabetes or glaucoma.
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FYI: Vision coverage is often quite affordable. Read my picks for dental and vision insurance for seniors to learn more.
In general, Original Medicare does not cover a routine eyeglass or contact lens exam; however, there are some exceptions to this rule, as Medicare may provide coverage for eye exams and vision care if a person has diabetes, glaucoma, macular degeneration, or cataract surgery.
If you have diabetes, Part B may cover diabetes-related eye exams. It covers medically necessary services and collects 80 percent of the cost of an eye exam for diabetic retinopathy once a year. You pay 20 percent of the amount approved by Medicare, including the deductible or any copayments at the outpatient hospital.
With Medicare Part B, you can get up to 80 percent coverage for a glaucoma eye exam if you are at high risk for developing glaucoma, an eye disease that can cause blindness. A certified optometrist must perform or supervise the examination.
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Medicare Part B covers eye exams for glaucoma every 12 months if you are considered at risk for diabetes or if you have a family history of glaucoma.
Medicare Part B covers certain diagnostic tests, including: treatment of eye conditions; some injectable drugs; and various other diseases of patients with age-related macular degeneration.
Medicare Part B can help pay for corrective lenses if a patient has cataract surgery to implant an intraocular lens. This coverage includes corrective lenses with a pair of glasses and a standard frame or a set of contact lenses. You pay 20 percent of the amount approved by Medicare.
Did you know: Some gaps in Medicare can be covered by Medigap supplement policies. Read my article on the best Medicare supplement plans to learn more.
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Although Original Medicare does not cover eye exams, other parts of Medicare can help cover the cost of medically necessary services for vision problems related to diabetes, glaucoma, or macular degeneration.
Medicare Part A (hospital insurance) does not cover routine eye exams for glasses and contact lenses, so you must pay 100 percent of the cost. However, Medicare Part A may cover medically necessary vision care under certain conditions if a patient has vision problems or has experienced a traumatic injury or other emergency that requires hospitalization.
Medicare Part B (health insurance) does not cover routine eye exams or refractions, so you must pay 100 percent of the cost. In some cases, Medicare Part B may cover 80 percent of the cost of a diabetic retinopathy eye exam once a year if you have been diagnosed with diabetes.
The exam must be performed by a government ophthalmologist, and you must pay 20 percent of the remaining Medicare-approved amount for services and hospital outpatient copays. In addition, Medicare Part B can cover annual eye exams for people with glaucoma and other high-risk diabetic patients who are at risk for vision problems that require medical attention. Part B can also cover cataract surgery and the fitting of an artificial lens, as well as vision care services such as standard-framed glasses, post-cataract surgery.
Vision And Dental Coverage With Medicare
Some Medicare Advantage plans (Part C) may offer additional benefits not normally covered by Medicare, such as vision, hearing, or dental. It is best to contact your Medicare Advantage provider for the most current information on out-of-pocket costs and coverage. With Medicare Advantage, you can get additional benefits, such as routine eye care that includes glasses and contact lenses.
Medigap or Medicare Supplemental Insurance is supplemental insurance that you can purchase from a private insurer. Medigap does not cover routine dental and vision care, such as eye exams, glasses or contact lenses. However, Medigap helps cover the cost of cataract surgery or other eye conditions. The rule of thumb is that if Original Medicare covers it, your Medigap plan will too. However, if Original Medicare doesn’t cover it, your Medigap plan won’t either.
FYI: Medical expenses for people with diabetes can exceed $9,600 per year. If you are looking for supplement plans, read my guide to Medicare Supplement Plans for Diabetes.
The average cost of an eye exam without insurance ranges from $50 to $70. Most insurance policies usually do not cover routine eye exams and may have additional co-payments. Because routine eye exams are usually not covered by Medicare, you pay 100 percent of their costs.
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If you are at risk for glaucoma or diabetes, Medicare Part B may cover annual eye exams every 12 months. For example, if you use Medicare Part B for a glaucoma eye exam, 80 percent of the exam is covered. However, you are still responsible for paying the remaining 20 percent of the Medicare-approved amount after meeting your Part B deductible.
Medicare Part B may cover certain diagnostic tests, including the treatment of certain eye diseases and conditions, such as age-related macular degeneration, which causes vision loss. You are responsible for paying 20 percent of the Medicare-approved amount for these vision services, plus the deductible or any copayments.
Medicare Part B can help pay for corrective lenses if you need cataract surgery to implant an intraocular lens. You will also receive glasses with standard frames or a set of contact lenses if medically necessary after cataract surgery.
In a nutshell, Original Medicare does not cover routine eye exams. However, under certain circumstances and conditions, Medicare may cover certain types of vision care. For example, Medicare Part B covers medically necessary screenings and eye exams for high-risk individuals who have glaucoma, diabetes, or macular degeneration.
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Also, if you have cataract surgery, Part B may cover medically necessary vision care, such as glasses or contact lenses. Medicare may also provide coverage for treatment or surgery for eye conditions such as corneal disease, eye injuries, or infections.
Let’s say you have an emergency and need to be admitted to the hospital for eye surgery. In this case, Medicare Part A may cover hospitalization and inpatient care after paying the deductible and 20 percent of the remaining costs. In addition, Medicare Advantage plans offer additional coverage that Original Medicare does not cover. So, check with your individual Medicare Advantage plan to see if they offer vision coverage.
Medicare doesn’t usually cover glasses or contact lenses, so you’ll have to pay 100 percent of the cost—except for certain eye conditions. In some cases, Medicare Part B can help you pay for corrective lenses if you’ve had cataract surgery to implant an intraocular lens.
After cataract surgery, you can get up to a pair of standard glasses or a set of contact lenses. If you’ve had cataract surgery and need glasses and other vision insurance, you still have to pay 20 percent of your Medicare-approved amount and deductible.
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While Medicare does not cover vision, hearing or dental procedures, there are some exceptions. For example, if you need eye surgery or have a chronic eye condition that puts you at high risk, Medicare may pay for cataract surgery or tests for high-risk diabetes patients.
Medicare covers cataract surgery unless it is performed using traditional surgical techniques or lasers. Medicare will be able to cover 80 percent of the cost of medically necessary cataract surgery after the deductible is met. In addition, Medicare Part B can help pay for corrective lenses after cataract surgery for intraocular lens implantation. If the procedure is deemed medically necessary, corrective lenses are covered by Medicare.
If you are looking for an ophthalmologist who accepts Medicare, visit the official Medicare website, click on the “Find Healthcare Providers” link and use the search tool to search for keywords, providers, specialties and locations.
If you want to check whether your Medicare covers certain medically necessary procedures or tests, the best place to check is with Medicare and your provider or applicable Medicare plan. Some important factors to keep in mind include out-of-pocket costs, deductibles and other additional costs that Medicare does not cover.
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To learn more about Medicare, how it works and what it covers, be sure to check out our set of guides:
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