According to the Centers for Disease Control, about 12 million people over the age of 40 in the United States have some form of impaired vision. 1 million of those are legally blind. Also, the CDC estimates that by the year 2050, over 8 million people will be blind due to the increase in diabetes and other eye-related diseases.
Because of the rapid incline of eye disease in the United States, especially for those 65 and older, you may wonder if Medicare covers vision care services. While Medicare covers some vision care, routine care is not typically included.
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Does Medicare Cover Vision Care Services?
If you are looking for coverage for your routine vision visits, you must find that coverage under a Medicare Advantage plan.
Does Medicare Part A Cover Vision Care?
Part A of Medicare covers hospitalization. In the case of a medical emergency or traumatic injury, Medicare Part A only covers vision care when it is considered a medical problem. Routine eye exams and refractions are not covered by Medicare Part A. If you do not have other vision coverage, you will pay 100% of the out-of-pocket costs.
Does Medicare Part B Cover Vision Care?
Medical insurance is part of Medicare Part B. However, routine vision exams are not covered by Medicare Part B. Medicare Part B does not cover eyeglasses or contact lenses unless you need vision correction after cataract surgery. Refractions of the eye are also not covered by Medicare Part B.
That said, if you are at high risk for Glaucoma, Part B will cover the screenings. Your doctor will deem you high risk based on your unique situation and family medical history.
Cataract surgery will also be covered by Medicare Part B. In the following months after cataract surgery, Medicare will cover the cost of the artificial lens used to replace the lens affected by cataracts and the cost of the prescription glasses you will need after the operation.
In the case of birth defects, trauma, or surgical eye removal, Medicare Part B vision benefits cover eye prostheses. The polishing and resurfacing of vision prostheses will be covered up to twice a year. Medicare will also pay to replace lost or stolen prostheses.
Because most eye disease treatments are outpatient, you will have to meet your deductible before Medicare coverage kicks in. Some coverage parts, like glaucoma screenings and cataract surgery, will also have a coinsurance.
Does Medicare Part C (Medicare Advantage) Cover Vision Care?
Medicare Advantage plans are a great way to get more coverage out of your Medicare plan, as it includes your original Medicare plus some extra benefits. Medicare Advantage includes routine vision care, unlike Part B, usually for higher premiums. Routine care includes optometry and ophthalmology.
Also, unlike Part B, Medicare Advantage plans can include prescription drug coverage. Some plans will include coverage for physician-prescribed eye drops and other medicines.
You can find a Medicare Advantage plan from a private insurer that suits you. Keep in mind that all Medicare Advantage plans will be different, and be careful when reading what coverage is included and excluded. Some plans will include vision care and prescriptions, and some may not.
Does Medicare Part D Cover Vision Care?
Medicare Part D is prescription drug coverage, so any drugs prescribed to you for covered eye diseases may be covered by Medicare Part D. Medications like eye drops or other necessary medication may be covered under Part D. This part of Medicare can be purchased from a private insurance company.
Does Medigap (Medicare Supplement) Cover Vision Care?
Medigap, or Medicare Supplement plans, can help supplement your coverage with your original plan, especially for those lacking. Most vision care (eye exams, glasses, contacts) is not covered by Medigap, other than cataract surgery costs or other major eye issues. Some Medigap plans can help pay for your coinsurance or deductible.
There is an abundance of different Medigap plans available, so be sure to get quotes from different insurers based on what gaps in coverage you are looking to fill.
How Medicare Covers Common Eye Diseases
Your Medicare plan will detail how different eye diseases may be covered. Some diseases may have more coverage than others and are subject to your Part B deductible and coinsurance.
When the clear lens of your eye begins to cloud, this is known as cataracts. This eye disease is can be particularly distressing to a person, as it is like looking through a constant fog. Cataracts typically develop slowly over time, and those with diabetes, high blood pressure, and obesity are at a higher risk.
Medicare Part B covers cataract surgery, as mentioned previously. As long as it is done with traditional surgery, where they replace your lens with an artificial one. It will also cover laser treatment of cataracts. Medicare will also pay for the corrective lenses after surgery.
The tiny blood vessels that line the back inner wall of the eye (retina) can be damaged or entirely blocked by too much blood sugar. This eye disease in diabetics is known as diabetic retinopathy.
If you are diagnosed with diabetes, Medicare Part B will pay to cover a yearly exam for diabetic retinopathy. The retina is the part of your eyeball that forms a visual image when it interacts with your optic nerve. Ensure that the eye doctor performing this exam is legally permitted to do so in your state. Medication, laser therapy, and surgery are all possible treatments.
Dry Eye Disease
While dry eye disease may not impair your vision, it can be painful and reduce your quality of life. Once diagnosed with dry eye disease, your physician will outline a road to treatment. Maintaining regular, ongoing treatment for chronic dry eye is imperative.
It is easier to treat your symptoms if they are still mild. The good news is while dry eye disease can be uncomfortable and annoying, it is treatable. If left untreated, this condition can cause severe problems in the future. Infections, inflammations, and vision loss are possible complications. Because dry eye disease is considered a disease, Medicare Part B will cover the testing and treatment.
Glaucoma is when increased pressure around your eye eventually affects your eyesight because it damages your optic nerve. Glaucoma is one of the leading causes of blindness in the United States for those over 60. While glaucoma develops slowly, the symptoms are usually so minor that the disease fully develops before you notice it.
If you are a high-risk candidate for glaucoma, Medicare will pay for you to have testing done once a year. Usually, you are considered high-risk if you have diabetes, a family history of glaucoma, are African American and over 50, or are Hispanic and over 65.
You lose your central vision when you have macular degeneration. No matter how close or far you look, you cannot see fine details. However, your peripheral vision will remain intact. For example, when reading a newspaper, you will not be able to read the words, but you can see the outside columns. For those over 50, macular degeneration is the leading cause of vision loss.
Some diagnostic tests and treatments for eye diseases and conditions may be covered by Part B. As the macula wears down, your vision suffers. The macula is the central portion of the retina. Many treatments may be available, including medication, laser treatment, and vision improvement aids.
This condition occurs when a thin layer of tissue (the retina) pulls away from its regular position at the back of the eye. A retinal detachment occurs when the layer of blood vessels supplying oxygen and nutrients to the eye is separated from the retinal cells.
It is possible to lose your vision permanently if you do not treat a detached retina immediately. Usually, outpatient surgery for a retinal detachment will be covered by Medicare, minus your deductible and coinsurance. If you have Medigap, that can help cover both of those. It may be possible you also have a copayment.
Vision Health Options Beyond Medicare
Medicare is not your only option for vision care. There are more insurance options to consider when you are concerned about coverage for eye diseases.
Medicaid is an option for some low-income families who meet specific qualifications. Each state runs its own Medicaid program, so it is essential to check your state’s eligibility and coverage. Because vision care is optional, some states will include it, and some will not. For states that do, the coverages are typically similar to Medicare Part B but be sure to read your policy.
Stand-alone Vision Plans
Many insurers offer stand-alone vision plans for purchase. They are usually inexpensive and may or may not have more coverage options than Medicare plans. You can usually get quotes for these types of policies from the same companies that offer Medigap policies. Anyone can purchase a vision policy regardless of age, and you can review the coverages offered in depth before committing.
Check your community for local programs you could be eligible for. There are often free options depending on your situation. You could find clinics that offer free eye exams or even treatment. Some local programs will even provide you with corrective lenses, usually only glasses and frames, not contacts. Some will offer pay-as-you-go options, a sliding scale based on income, a flat rate, and sometimes even free. Local programs typically also accept Medicaid, so if your plan has gaps in coverage, local programs could help supplement those.
Optometry and Ophthalmology Schools
Another option to consider for eye care is optometry and ophthalmology schools. Of course, the physicians performing your work are students, but they are closely monitored and supervised by a faculty member to ensure quality care. While visiting a school for eye care can help cut costs, there is a risk since the students still need to complete their education fully. Additionally, they may only offer care for some eye diseases or treatment options, and you could find it hard to get an appointment.