Vision Coverage on Medicare: What You Need to Know

Millions of Americans experience vision problems. This number continues to rise as the population ages. In fact, a study by the National Institutes of Health indicates that by 2050 the number of Americans with a vision problem will hit more than 8 million people, double what it is today.
If you’re on Medicare and experience vision problems, you may be wondering about your coverage for eye exams and vision care. The risk of vision loss increases with age but most routine eye exams are not covered by Basic Medicare (Parts A and B).
So what is covered and what do you need to know about your vision coverage on Medicare?

What Eye Exams are Covered on Basic Medicare?

Medicare Part A, or hospital insurance, does not cover eye exams or vision unless the treatment takes place during hospitalization. For example, if you experience trauma to the eye and go to the hospital, Medicare Part A will likely cover your treatment. However, a regular contact or eyeglasses exam would not be covered under Medicare Part A.
Medicare Part B does not cover routine eye exams either but does cover some diagnostic and preventative tests, including:

  • Yearly eye exams for diabetics to screen for diabetic retinopathy.
  • Glaucoma testing every 12 months for those at high-risk for the disease. This includes those with diabetes, a family history of glaucoma, African Americans who are 50 or older and Hispanics who are 65 and older.
  • Medicare Part B may also cover the diagnosis and treatment of macular degenerationincluding treatment with certain injectable drugs.
  • Cataract surgery and glasses or contacts needed as a result of the surgery.

In each case, you will typically pay 20 percent of the approved Medicare cost, plus your Medicare Part B deductible and copay if applicable. Make sure you receive treatment from someone who is legally allowed to do the test in your state. This can make the difference between your exam/treatment being covered or not covered by Medicare.

How Can I Get Medicare Coverage for Routine Eye Exams?

Many people seeking vision coverage for routine visits opt for a Medicare Advantage (Medicare Part C) plan. These plans are offered by private insurance companies that partner with Medicare to provide services.
Medicare Advantage plans cover all of the vision benefits provided in Medicare Part B, plus additional coverage depending on your specific plan. Some Medicare Advantage plans cover routine eye exams, contact lenses and eyeglasses. A SelectQuote licensed sales agent can help you find a plan that includes the vision coverage you desire.
When signing up for Medicare, or using your Medicare benefits, it’s important to understand what is and is not covered. It can be the difference between paying high dollar amounts out of pocket, and getting the care you need covered.
If you are one of the millions of Americans experiencing vision problems, make vision care a priority when selecting your Medicare plan. You’ll be thankful you understand your vision needs and know the plan you selected works for you.
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