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What to Know About Medicare and Vision Coverage

On Behalf of | Aug 23, 2017 | Firm News

August is Nation Eye Exam Month

Does Medicare cover routine eye exams?  What about a medical emergency?

Medicare Part A is hospital insurance and will cover vision care only when the vision condition is considered a medical problem such as an emergency or traumatic injury when you are admitted to the hospital.  Medicare Part A does not cover routine vision exams, therefore 100% of the cost is on you or your supplemental vision coverage policy.

Medicare Part B is medical insurance and covers some vision care, but not routine vision exams or vision correction such as glasses or contacts.  However, Medicare Part B does cover yearly glaucoma screenings for people who are at high risk, such as those people with a family history of glaucoma, African Americans age 50 and older, Hispanic Americans age 65 and older, and people with diabetes.  State-approved vision care specialists are the only providers that may perform yearly glaucoma screenings.  You will still pay the 20% Medicare coinsurance costs.

Medicare Part B covers cataract surgery, including the cost of the artificial lens to replace the lens affected by the cataract.  This is the only time that Medicare will cover the costs of corrective vision products such as glasses with standard frames.  Again, you will still be responsible for the 20% Medicare coinsurance cost.

Medicare Part B will also cover eye prostheses for someone with absence or shrinkage of the eye due to birth defect, trauma, or surgical removal, as well as ocular photodynamic therapy with vereporfin for patients with macular degeneration.  Diagnostic tests and treatment for certain eye diseases, such as lucentis and aflibercept are also covered under Medicare Part B.

To ensure that you are celebrating National Eye Exam Month each August you may be interested in obtaining vision coverage through your Medicare Part C vision benefits plan.  Medicare Part C or Medicare Advantage plans and Medigap or Medicare Supplement plans may often include other benefits in addition to Parts A and B.  This includes routine vision, routine dental, and Medicare Prescription drug coverage.  You may pay a higher premium for the advantage or supplemental plan that includes a vision or dental plan.

To find out if you are covered for routine vision exams, contact your advantage or supplemental plan provider and request a complete copy of your coverage plan.