Being able to feel secure when dealing with one’s vision and vision care needs can affect the overall wellbeing of the patient, it can also allow room for discussion and planning for any given treatment and its expenses. For Medicare beneficiaries enrolled in Original Medicare or Medicare Advantage are provided coverage that may vary depending on the plan enrollees have.
1. Does Medicare Cover Vision?
Original Medicare does not cover normal vision care, Medicare plans cover the following:
- Medicare Part A may only cover vision care in the event of a condition or incident involving the eye that results in hospitalization as an inpatient.
- Medicare Part B may only cover a portion of the cost for a pair of glasses or a pair of contact lenses that are medically necessary after cataract surgery where an artificial intraocular lens was inserted after surgical removal of the patient’s clouded natural lens.
- Medicare Advantage is a comprehensive benefit plan that pays for all the same things that Original Medicare covers and is administered through private insurance companies.
- Advantage plans offer supplemental coverage for some services that Medicare Part A and Part B may not cover including some vision insurance for seniors through private vision insurance carriers such as EyeMed or MES or VSP.
2. Does Medicare Cover Vision Screening for Those at High Risk of Developing Glaucoma?
Even though Original Medicare provides no coverage for routine vision care, if you have an increased risk of developing glaucoma, Medicare Part B will cover a preventive screening visit once per year to help rule this out. Patients who are at the highest risk of developing glaucoma who would be included in this category include:
- African Americans who are over the age of 50.
- Hispanic Americans who are over the age of 65.
- Patients with a positive history of diabetes.
- Those with a strong family history of glaucoma.
3. Does Medicare Cover Cataract Surgery?
Original Medicare does cover the cost for cataract surgery along with all costs that are related to the surgery. Cataract surgery involves removing a clouded natural lens and inserting an artificial intra-ocular lens in its place. After the surgery, Medicare may pay for either one pair of eyeglasses or one pair of contact lenses which are medically necessary to correct your post-operative vision after the cataract surgery. For more information visit Does Medicare Cover Cataract Surgery?
4. Does Medicare Cover Routine Refraction Exams to Correct Vision?
A refraction exam refers to an examination by an eye doctor to measure the amount of correction you may need in either glasses or contact lenses to correct any refractive error you may have to achieve your best vision possible. Medicare does not pay for routine eye refraction tests, but this benefit is covered by some Medicare Advantage plans.
5. Does Medicare Pay for the Diagnosis and Treatment of Macular Degeneration?
Macular degeneration refers to a loss of central vision. When it is related to aging, as is common with many patients with Medicare, it is then referred to Age-Related Macular Degeneration. Medicare Part B may pay for the following:
- The diagnosis and treatment of macular degeneration.
- May also pay for certain medications used to treat macular degeneration.
6. Does Medicare Cover Eye Prostheses?
If you have suffered the loss of an eye due to either trauma, surgery, or an eye disease, Medicare may cover the following:
- All the costs of the prostheses (artificial eyes).
- All costs for the polishing and restructuring of the artificial eye if required.
- Medicare may also pay for a replacement of the prostheses every five years.