Medicare does not cover routine eye exams, but there are a few exceptions. In this blog post, we will discuss when Medicare will cover an eye exam and what you need to do to qualify. We will also provide a list of services that Medicare does cover when it comes to your eyes.
What Will Medicare Cover When It Comes to Eye Care?
There are a few instances in which Medicare will cover an eye exam. These include:
- If you have diabetes, glaucoma, or macular degeneration
- If you are experiencing symptoms such as vision loss, changes in your vision, flashes of light, or floaters
- If you are going to have cataract surgery
- If you are going to have surgery on your retina
These are just a few of the instances in which Medicare will cover an eye exam. If you have any questions about whether or not your specific situation qualifies, we encourage you to contact us for more information.
What Services Does Medicare Cover When It Comes To Your Eyes?
In addition to the eye exams that Medicare will cover under certain circumstances, there are a few other services related to your eyes that Medicare will help you with. These include:
- Cataract surgery
- Glaucoma screenings
- Macular degeneration screenings
- Diabetic retinopathy screenings
How Often Will Medicare Pay For Eye Tests?
The frequency with which Medicare will pay for eye exams and screenings depends on the condition being monitored. For example, if you have diabetes, you will need to have an annual dilated eye exam. If you are over the age of 65, you will need to have a glaucoma screening every 12 months.
Are Optometrists Covered by Medicare?
Optometrists are not covered by Medicare. However, if you see an optometrist for a reason that Medicare does cover (such as an annual glaucoma screening), they will likely accept Medicare Assignment. This means that they will agree to accept the Medicare-approved amount as payment in full. You will still be responsible for any deductibles and coinsurance.
Do Medicare Advantage Cover Eye Exams?
Original Medicare (Part A and Part B) does not cover routine eye exams. However, some Medicare Advantage Plans (Part C) offer vision coverage. This means that if you have a Medicare Advantage Plan, you may be able to get routine eye exams covered.
If you would like to learn more about whether or not your specific plan covers routine eye exams, we encourage you to contact us. We would be happy to help you figure out what your plan covers and how to get the coverage you need.
Does Medicare Supplement Plans Cover the Optometrist?
No, Medicare Supplement Plans do not cover the optometrist. However, as we mentioned before, if you see an optometrist for a reason that Medicare does cover (such as an annual glaucoma screening), they will likely accept Medicare Assignment. This means that they will agree to accept the Medicare-approved amount as payment in full. You will still be responsible for any deductibles and coinsurance.
Are There Separate Vision Programs That Can Help?
There are a few separate vision programs that can help if you need assistance paying for routine eye care. These include:
- Vision Discount Plans
- Chains Offer Programs to Seniors
- VSN is a stand-alone vision program
- Healthy Eyes
How Much Does Advantage Plans Cover Towards an Exam?
Medicare Advantage Plans are required to cover at least the same benefits as Original Medicare. This means that if your plan covers routine eye exams, it must cover at least 80% of the Medicare-approved amount. You will be responsible for any deductibles and coinsurance.
When it comes to vision and your eyes there should not be a price tag on those needs. We have been in the industry for a long time and have heard horror stories about how expensive just a standard pair of glasses can cost. That is why we have taken the time to compile a list of the carriers that give the most generous amount to frames and lenses as well as cover the exam at 100%. The key is going to a network provider and understanding which plan gives you the most coverage for vision care. If you have a particular need or an ailment that requires the need for more attention when it comes to your eyes don’t worry. We can gear our search to a plan designed to help with that particular ailment. Please give us a call with any questions you may have.