Traditional Medicare covers some services related to vision care under Medicare Part B.
Some people who choose Medicare Advantage, which is Medicare’s bundled plan, may also be able to receive additional vision benefits. This depends on their specific plan.
This article will cover which aspects of vision care that Medicare may cover.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B is available through traditional Medicare as well as Medicare Advantage, wherein private insurance companies provide Medicare benefits.
For a premium of $144.60 per month in 2020, Medicare covers a range of medical services. This includes the following vision benefits:
- annual glaucoma tests for those at high risk
- annual exams to test people with diabetes for diabetic retinopathy
- cataract surgery, plus one postsurgical pair of eyeglasses or contact lenses, as long as the person buys them from a Medicare-approved supplier
- specific screenings and tests for age-related macular degeneration (AMD)
Traditional Medicare does not usually cover routine vision care. If a person has this type of plan, they will be entirely responsible for any costs related to eye exams, eyeglasses, and contact lenses.
However, those with a Medicare Advantage plan often receive vision benefits.
This may include routine eye exams, or refractions. A person should carefully read their Medicare Advantage policy document to determine which exam types it includes and how much the policy covers.
Medicare covers glaucoma screening for those at high risk of the condition. According to the National Council on Aging, this includes the following groups:
- African American people who are at least 50 years of age
- people with a family history of glaucoma
- those with diabetes
- Hispanic people who are at least 65 years of age
A person will pay 20% of the Medicare-approved amount for their exam. The Part B deductible also applies, so if a person has not yet met their deductible, they may need to pay more.
Without detection or treatment, glaucoma can lead to blindness.
The condition does not usually cause symptoms until its later stages. This means that it is important to undergo regular eye exams, especially for people with a high glaucoma risk.
Traditional Medicare does not usually pay for eyeglasses. An exception would be eyeglasses that a person needs after cataract surgery.
Traditional Medicare also does not pay for routine eye exams, which a person would usually require to get a prescription for eyeglasses.
However, Medicare Advantage plans may cover some or all costs related to new eyeglasses. However, the plan may require a person to get their eyeglasses from a specific supplier that has an agreement with Medicare.
Medicare Part B covers once-yearly diabetic retinopathy eye exams. However, there are a few stipulations. For example, a person must see a doctor who the state has authorized to conduct these eye exams and who has a contract with Medicare.
A person’s Part B deductible will still apply, as will a 20% coinsurance. Their doctor must inform them if Medicare will not cover certain aspects of their eye exam.
Individuals with diabetes have an increased risk of diabetic retinopathy, which is a condition that affects the vessels supplying blood to the retina.
The National Institutes of Health (NIH) recommend that people with diabetes receive a comprehensive dilated eye exam at least once per year. The early diagnosis and treatment of diabetic neuropathy can prevent vision loss and blindness related to diabetes.
Medicare Part B covers certain tests and treatments related to AMD. An example includes some drugs that a doctor injects directly into the eye to help treat the condition.
A person is responsible for meeting their Part B deductible before Medicare will pay for treatment. They must also pay for 20% of the medication and doctor’s services.
AMD is an eye condition that reduces a person’s central vision, or the ability to see straight ahead of them.
The condition can cause blurred vision and significant vision loss that may make it difficult for a person to see faces, read, and drive safely.
Medicare may cover eye surgery, depending upon the circumstances of the surgery. For example, if a person has an eye-related emergency that requires a hospital stay — such as a foreign object in the eye — Medicare will usually cover the costs of this hospital stay.
That said, a person may be responsible for coinsurances and copayments related to the stay, as well as their Part A deductible.
Some people may require surgery to correct cataracts, which causes cloudy areas of vision. An eye doctor will remove the cataract and insert an artificial lens to help a person see more easily.
Eye doctors usually perform cataract surgery on an outpatient basis. People will pay an average of $202 for surgery center costs or $404 for services that they receive in a hospital’s outpatient surgery department.
This does not include costs for medications or doctor’s fees. Ideally, a doctor should be able to provide a person with an estimated explanation of cataract removal costs under Medicare.
People often require corrective eyeglasses or lenses following cataract surgery. Medicare will usually cover those, on the condition that the person buys them from a Medicare-approved provider.
Even if a person does not have vision coverage through traditional Medicare or Medicare Advantage, there are resources outside of Medicare that may help them pay for vision care.
Some examples include:
- EyeCare America: This organization is part of the American Academy of Ophthalmology Foundation and provides eye exams for people with lower incomes.
- SightFirst: This is a plan, operated by Lions Club International, that helps people receive vision support, including eyeglasses.
- Mission Cataract USA: This program provides cataract surgery for those who may not otherwise be able to meet the costs.
- New Eyes for the Needy: New Eyes for the Needy is a program that helps people in need obtain single or lined bifocal lenses. However, a person must be able to obtain an eye exam and eye prescription before applying for the eyeglasses.
A person may also be able to contact their health department or state Medicaid department for assistance with vision care.
Traditional Medicare covers some aspects of vision care. However, this will typically be for people who are most at risk of eye-related complications.
A person may wish to buy expanded coverage by purchasing a Medicare Advantage policy.
If a person qualifies for low income resources from their state’s Medicaid program, they may also receive assistance for vision care.