Medicare beneficiaries have several options for coverage when it comes to their vision care. In this blog post, we will explore what Medicare covers. As well as how to get the most out of your benefits. We will also discuss the different types of eye exams that are available and how to find a provider in your area. So, whether you are just starting to think about your Medicare coverage or you need to schedule an eye exam, read on for more information!
Does Medicare Pay for Glasses?
Post-cataract services provided by an optometrist can be covered.
If the optometrist is licensed to provide this service in your state:
- Medicare will pay only for standard frames.
- Eyeglasses and contact lenses are covered even if you had the surgery before you had Medicare.
- Both eye lenses may be covered even if you had your cataract surgery on one eye only.
A prescription order signed by your doctor (ophthalmologist or optometrist) must be on file with the supplier. Suppliers must be enrolled in Medicare and must meet strict standards to qualify for a Medicare supplier number. Medicare won’t pay your claim if your supplier doesn’t have a number, even if your supplier is a large chain or department store that sells more than just durable medical equipment (DME).
After each cataract surgery with an intraocular lens, you pay 20% of Medicare-approved amounts for one pair of eyeglasses or one set of contact lenses, after the Part B deductible, if applicable.
Medicare will only reimburse or pay for the standard eyeglass frame amount. You pay an additional cost for upgraded frames.
For more information about Medicare eye care, you may call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week.
Note: Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment. If the supplier is a participating supplier, it must accept the assignment. If the supplier is enrolled in Medicare but isn’t “participating,” it has the option to accept the assignment.
Does Medicare Cover Glaucoma Screening?
Glaucoma is a condition that damages the optic nerve, which carries information from your eye to your brain. Glaucoma usually happens when the pressure inside your eye is too high. If you have glaucoma, you may not have any symptoms at first. That’s why it’s important to get regular screenings, so the condition can be caught early and treated.
Medicare Part B (medical insurance) covers glaucoma screenings once every 12 months for people at high risk for this condition. If you’re not at high risk, you may still be covered for screening if your doctor accepts Medicare assignment.
You pay 20% of the Medicare-approved amount for the glaucoma screening after you meet your Part B deductible.
The member will nothing if the doctor or other health care provider accepts the assignment.
If you have a Health Savings Account (HSA) or a Medical Savings Account (MSA), you can use those funds to pay for your share of the glaucoma screening cost.
For more information about glaucoma screenings, you can call the National Eye Institute at (301)496-5700.
What Is a Diabetic Retinopathy Screening?
Diabetic retinopathy is a condition that can occur in people with diabetes. It happens when high blood sugar levels cause damage to the blood vessels in the retina (the back part of the eye). Diabetic retinopathy is a leading cause of blindness in adults.
Screenings can help find diabetic retinopathy early before you have symptoms. Early treatment can often delay or prevent vision loss.
Medicare Part B (medical insurance) covers one diabetic retinopathy screening once a year for people with diabetes who have Part B. The Patient must get this screening from an eye doctor or other health care provider who accepts Medicare assignments.
Then you pay 20% of the Medicare-approved amount after you meet your Part B deductible.
The client pays nothing if the doctor or other health care provider accepts the assignment.
If you have a Health Savings Account (HSA) or a Medical Savings Account (MSA), you can use those funds to pay for your share of the diabetic retinopathy screening cost.
Does Medicare Advantage Cover Eyeglasses and Exams?
There is still Medicare Part B coverage even when covered by an Advantage Plan. This means that you can get one glaucoma screening and one diabetic retinopathy screening every year. You’ll also pay 20% of the Medicare-approved amount for these screenings after you meet your Part B deductible.
In addition, most Medicare Advantage Plans cover routine vision services. This can include an annual eye exam and eyeglasses or contact lenses (after a copayment). Some plans may also cover the cost of refractive surgery, like LASIK.
To find out if your plan covers routine vision services, contact your plan directly.
In conclusion, keeping up with your vision is very important. If you have any questions on what plans will help you the most with vision coverage. Please give us a call.