Traditional, or original, Medicare covers some services related to vision care. However, it does not typically cover routine eye exams.
This article explores which aspects of vision care 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.
Parts A and B of original Medicare do not usually cover routine vision care, including eye exams. If a person has this type of plan, they will be entirely responsible for any costs related to eye exams, eyeglasses, and contact lenses.
- glaucoma screening for people with a high risk
- diabetic retinopathy eye exams
- age-related macular degeneration (AMD) diagnostic tests and treatment
Medicare Part B covers one glaucoma test every 12 months for people with a high risk of developing the condition. This includes:
- African American people who are at least 50 years old
- Hispanic people who are at least 65 years old
- anyone with a family history of glaucoma
- anyone who has diabetes
Glaucoma does not usually cause symptoms until its later stages, but without treatment, it can lead to blindness. Therefore, it is essential for everyone to have regular eye exams, especially people with high risk of glaucoma.
Medicare Part B covers yearly diabetic retinopathy eye exams. A person needs to see a doctor authorized by the state to conduct these exams. The doctor needs to have a contract with Medicare.
People with diabetes have an increased risk of diabetic retinopathy, which affects the vessels that supply blood to the retinas. The
Medicare Part B covers certain tests and treatments related to AMD, an eye condition that can cause significant vision loss.
Part B may cover the costs of tests to diagnose AMD and monitor its progress, as well as some drugs that a doctor injects into the eye to help treat the condition.
Although Medicare Part B does not cover routine eye exams, it may cover specific exams for glaucoma, diabetic retinopathy, and AMD.
The monthly premium for Part B in 2021 is $148.50.
A person also must pay 20% of the Medicare-approved amount for any eye care that Part B does cover. The deductible of $203 also applies, so if a person has not yet met their deductible, they may need to pay more.
Meanwhile, Medicare Advantage plans, which are administered by private insurance companies, often provide vision care benefits. In fact, vision is the most common supplemental benefit among Advantage plan enrollees. Around
This coverage may include routine eye exams. It is important to research various Advantage plans to find the one with the best combination of coverage.
A person may qualify for Medicaid, depending on their income and resources. Medicaid covers medically necessary eye care, including treatment for eye injuries and conditions. Routine eye exams are not typically included, but Medicaid does cover eye exams that a doctor deems medically necessary.
A person can contact their state Medicaid department to ask about assistance with vision care.
Even if a person does not qualify for Medicaid and has no coverage through Medicare, other resources can help with paying 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 program, operated by Lions Club International, helps people receive vision support, including eyeglasses.
- Mission Cataract USA: This program provides cataract surgery for people who may not otherwise be able to afford it.
- New Eyes for the Needy: This program helps people obtain single or lined bifocal lenses. A person needs to have an eye exam and receive a prescription before applying for the glasses.
Original Medicare covers some aspects of vision care, but typically only for people with a higher risk of certain eye conditions.
A person may receive expanded coverage by purchasing a Medicare Advantage plan.
Other programs, including Medicaid and some privately run organizations, can also help cover the costs of vision care.