Skip to main content

Does Medicare Cover Eye Exams?

The Medicare Advantage plan covers Medicare eye exams and other benefits relating to vision coverage. However, Original Medicare does not offer vision exams, frames, lenses, or contact lenses. These will have to be paid out of pocket if this is the plan you currently have. In some instances, some diagnostic and prevention vision screenings are covered.

It is best to enroll in Medicare Advantage, also known as Part C if vision coverage is the main priority you’d like coverage on. Depending on what is needed, it is best to read through Medicare’s plans to choose the correct one with the desired visual coverage. 

Vision is extremely important and needs to be well taken care of, especially as we age. That is why it is a good idea to have health coverage that will aid in helping preserve your eyesight and take care of existing conditions. 

How is Medicare Beneficial To Me?

Medicare has an extraordinarily high number of those who are covered by its variety of plans. There are many benefits that are offered. The availability to choose a plan that tailors to an individual’s specific needs is why so many flock to this Health Insurance Coverage provider. 

The monthly cost of Medicare is highly minimal compared to the cost of operations, prescriptions, and other associated expenses that would not be covered and paid out of pocket instead. The amount of money you save by using Medicare is undoubtedly very beneficial. If enrolled in the Original Medicare option, you will receive Part A hospital insurance and Part B medical insurance program benefits. When enrolling in Medicare Advantage, you receive Part A and Part B’s benefits. Still, this plan has much more to offer, also known as Part C. Many of the procedures and medical care that aren’t covered in these two Parts are covered by Medicare Advantage. 

There is also a Part D that can stand on its own. This option covers medications prescriptions primarily. However, if deciding to choose the Medicare Advantage, you may look for a plan to include Part D if ongoing or post-procedure medication is needed.

This is why it is recommended to speak to a consultant or inquire online about which of these plans will be best for you. They cater to many situations and future coverage in case of accidents or unforeseen illnesses. 

Will Medicare Cover My Eye Examination?

Does Medicare Cover Eye Exams - Eye Exam | Healthier Me Today

Routine eye examinations are essential for maintaining and looking after your eyesight; therefore, it is suggested to go for an eye exam roughly once every year. The reasoning behind these tests and examinations is to identify potential visual problems such as glaucoma, diabetic retinopathy, macular degeneration, or cataracts. As previously discussed, there are different parts to Medicare, A, B, C, and D. Original Medicare (Parts A and B) does not generally cover routine eye examinations; however, Medicare Part B will cover eye exams every 12 months if you meet specific criteria.

Medicare Advantage (Part C) includes Part A and B and offers a range of different coverage on other aspects and procedures. Depending on what condition or impairment you have, it is wise to read through all of Medicare plans to find one that best suits the needed eye care you are looking for or in the hopes of preventing a hereditary condition. 

There is a criterion that needs to be met by an individual! Medicare beneficiaries will accept enrollment into a program that contains the eye care benefits they need. This will include:

  • Those with diabetes are at risk of developing a condition called diabetic retinopathy. This can cause vision loss due to the blood vessels in the retina not receiving a proper blood supply. This happens when blood sugar levels become elevated, damaging blood vessels and restricting the supply amount. People who have diabetes will be covered by Medicare for diabetic retinopathy detection exams once per year. 
  • People who have a high risk of developing glaucoma, such as those with a family history of the condition, African Americans aged 50 or older, who have diabetes, or are Hispanic and aged 65 or older. This grouping and others at risk will be able to go for glaucoma tests once every 12 months covered by Medicare.
  • Macular degeneration is a condition that causes loss of vision and the ability to see objects in front of you, making it very dangerous to drive and lessening the ability to read. Medicare may cover some diagnostic treatments and testing if the condition is related to age.
  • There are some aspects of cataract surgery that Medicare covers. When the lens of your eye becomes cloudy, it proves challenging to focus on images and surroundings, causing blurred vision and also faded eyesight are some of the effects cataracts cause. What Medicare covers for this condition are the placement of an intraocular lens, a small clear disc that will replace the lens that has become clouded. Following each IOL insertion surgery as aforementioned, Medicare will provide contact lenses or a pair of glasses.  
  • Once meeting a yearly deductible, you are then responsible for 20% of the approved costs of Medicare Part B. this Part covers the previously mentioned eye exams. 

What if I have had Previous Eye Issues?

Medicare Advantage also referred to as Part C, has coverage for eyeglass frames, lenses, and contact. With this being said, visual aids such as glasses and contacts will be provided for pre-existing eye issues. Most of these plans include Part D, which covers prescription medication. You can have any treatment and prescriptions covered that are used or related to eye conditions. Including medication for recurrent eye infections and dry eyes. 

Who is More Likely to be Eligible Medicare Eye Care?

Does Medicare Cover Eye Exams - eye equipment | Healthier Me Today

Medicare is catered to aid those 65 years of age or older. Those younger need to first fit into a certain category before being accepted. This category is whether an individual has a disability or permanent kidney failure. 

There are, however, exceptions if the person is mainly looking into plans with eye care support. Yet again, a certain criterion has to be met. 

Those who have eye conditions stemming from age or diabetes and hereditary issues. These are more likely to have easy enrollment than others who don’t have these problems. 

Let’s Take a Closer Look

Medicare does cover eye exams, but it will solely rely on which plan you choose. For example, original Medicare does not cover routine eye examinations; however, they cover some other types of eye exams. Medicare Advantage, in other words, provides many benefits that Original Medicare does not, for example, the aforementioned routine eye exams.

HMT News Team

HMT News Team 

You can consider Healthier Me Today your one-stop health resource, the all-in-one online handbook you can take wherever you go! Healthier Me Today covers everything you need to know about your health.