Original Medicare plans do not provide vision coverage. Due to this, Part A and Part B do not cover contact lenses, but some Medicare Advantage (Part C) plans may offer this benefit.
Original Medicare has many benefits, covering a range of services and treatments. However, eyesight coverage does currently receive inclusion.
When people require corrective lenses, they may have to look for alternative options, and other Medicare plans may have some vision benefits.
In this article, we look at the coverage options for prescription contact lenses and eye care and the situations in which Medicare may cover the costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare parts A and B do not cover the cost of contact lenses, eyeglasses, or routine eye exams in most cases.
If a person has a Medicare Advantage (Part C) plan, they can check with their plan provider to see whether it covers contact lenses.
As people age, they may experience shifts in their vision, and older adults with healthy eyes and sight may encounter changes.
Presbyopia can begin when a person is in their late 30s or early 40s. This means it can be difficult to focus on things up close, and items or objects may appear blurry.
Some older adults may experience changes in visual acuity, such as:
- the eyes taking longer to focus and adjust to varied light conditions
- loss of contrast sensitivity, which is when it is difficult to distinguish between slight variations in tone and color
- increased light sensitivity that could make everyday activities, such as driving, more challenging
Rod cells are responsible for these visual challenges. The health of rod cells is partially dependent on environmental factors, such as:
- nutrition
- smoking
- prolonged sun exposure
Medicare may cover some types of eye care, and where coverage is available, a person needs to obtain contact lenses or eyeglasses from a Medicare-enrolled supplier only.
If a person is 65 or older, it is important to visit an ophthalmologist for an exam at least once every 2 years. The ophthalmologist will check for any age-related eye diseases.
Glaucoma
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A person may also be at high risk for glaucoma due to diabetes or a family history of glaucoma.
Testing for glaucoma is available through Part B, and a 20% coinsurance applies, along with any outstanding deductible.
Diabetic retinopathy testing
If a person has diabetes, Medicare Part B may cover a yearly exam. A Medicare-approved eye doctor who is legally allowed to conduct the test in the state must carry out the exam. Any remaining deductible and a 20% coinsurance will apply.
Macular degeneration testing
If a person has age-related macular degeneration, Medicare Part B may cover diagnostic tests and some injected prescription drugs to treat the disease.
If an individual receives treatment in the hospital, the Part A copayment may be payable, along with the deductible.
Cataract surgery
Medicare Part B may help pay for corrective lenses if a person has cataract surgery to implant an intraocular lens.
Medicare-covered corrective lenses include one pair of eyeglasses with standard frames or one pair of contact lenses.
Out-of-pocket costs will be due, and there may be additional costs for upgraded frames.
Dilated eye exams
Eye doctors perform dilated eye exams to check for a number of diseases and check a person’s vision. The test is straightforward and should not involve any pain — the NEI considers it one of the best ways to maintain eye health.
For adults ages 60 and over, experts recommend that a
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- eating a balanced diet that includes fish that is high in omega-3 fatty acids and dark, leafy greens
- maintaining a moderate weight
- keeping diabetes under control
- wearing sunglasses and a hat with a brim when outdoors
Regular exercise
The eyes require healthy blood circulation and oxygen intake, which improve through regular exercise. An older adult may try walking, yoga, or gentle stretching as an effective way to maintain physical health.
Adequate sleep
Over the course of a day, irritants can get into the eyes. These include:
- dust
- pollen
- smoke
- makeup
- dropped eyelashes
- chemicals from household products
- certain fragrances
As a person sleeps, their eyes are continuously lubricated, helping to soothe and restore the eye and remove irritants that have accumulated during the day.
Original Medicare does not cover the cost of contact lenses, eyeglasses, or routine eye exams.
Medicare Part B may cover glaucoma tests, macular degeneration tests, diabetic retinopathy tests, and cataract surgery, which may sometimes include lenses.
A person can protect their eye health by getting plenty of sleep, exercising regularly, managing their weight, and visiting their ophthalmologist and primary care doctor regularly.