Q: How does Medicare cover vision services and treatment?
A: Medicare won’t pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions.
Regular vision care is important at any age, but it’s especially crucial for seniors, as they’re more prone to eye disorders and disease. Unfortunately, seniors are by no means guaranteed complete vision coverage under Medicare, so it’s important to know what to expect.
Routine vision services
We all need to have our eyes checked regularly to ensure that we’re seeing properly. Unfortunately, Medicare won’t pay for routine vision services like eye exams, prescription glasses, or contact lenses. The only exception is if you have a medical condition that requires custom eyeglasses or contact lenses, in which case Medicare might pick up the tab.
On the other hand, Medicare Advantage generally covers standard vision testing, as well as glasses or contacts. If you’re going to stick to original Medicare but want coverage for routine vision services, supplement insurance won’t solve that problem – Medigap won’t pay for vision care or eyeglass benefits, either.
Glaucoma is a disease that damages the optic nerve, potentially resulting in vision loss. Medicare Part B will cover annual glaucoma screenings for those considered high-risk, including diabetics and older Americans with a family history of the disease. African Americans aged 50 and older, and Hispanic individuals aged 65 and over are also considered high-risk. You’ll still be responsible for your Part B deductible and 20 percent of the cost of your exam.
Glaucoma treatment is generally covered under Medicare. Outpatient laser surgery falls under Part B, and eye drops to address the condition fall under Medicare Part D. Your out-of-pocket costs associated with your drops will depend on your Part D plan’s formulary.
Because Medicare Advantage is required to provide the same level of coverage as original Medicare, it does pay for glaucoma screenings and treatment. Medigap, meanwhile, can cover some or all of the costs associated with your glaucoma screening and treatment under Medicare by picking up the tab for your deductibles and coinsurance.
Diabetic retinopathy can damage blood vessels in the eye, causing vision problems and loss. If you’ve been diagnosed with diabetes, Medicare Part B will pay for one exam per year to get ahead of brewing eye problems. You’ll still pay 20 percent of the Medicare-approved amount for your exam, and your Part B deductible will apply if you haven’t met it yet.
Treatment is often addressed at targeting the underlying condition – diabetes – and Medicare Part D will generally cover medications associated with doing so. If your out-of-pocket costs are substantial after covered treatment, your Medigap plan can defray that cost. And if you have an Advantage plan, it will pick up the tab for your annual screenings and underlying treatment.
Age-related macular degeneration
Age-related macular degeneration (AMD) is the leading cause of vision loss in adults 50 and over. Medicare Part B will cover diagnostic tests and treatment for AMD, which may include drops or eye injections. As is the case with other covered services, you’ll still be responsible for 20 percent of the cost of your services or treatment after meeting your deductible, so look to your Medigap plan for help there. Medicare Advantage will cover diagnostics and treatment for AMD as well.
Cataracts cloud the lens of the eye, making it difficult to see. Surgery is generally needed to correct the condition, and under original Medicare, you have two choices in this regard.
First, you can receive a basic lens replacement, paid in full by Medicare up to $2,000. Or, you can apply that amount to a replacement lens that not only addresses the cataract, but also corrects for near or farsightedness, and then pay the difference. Additionally, Medicare will cover corrective eyeglasses or contacts that are necessary following cataract surgery.
As is the case with other medical procedures, with cataract treatment, you’ll still be responsible for your Part B deductible and 20 percent coinsurance. If you have a Medigap plan, it can pick up some or all of these out-of-pocket costs. And if you’re on Medicare Advantage, your out-of-pocket costs may be lower, depending on what plan you have.
A detached retina can cause permanent vision loss if not treated quickly. Medicare will cover surgery (generally outpatient) to repair a detached retina, but you’ll be responsible for your Part B deductible and 20 percent coinsurance, which Medigap can help take care of. Depending on where you have your procedure, a copayment might apply as well. Similarly, Medicare Advantage will pay for the cost of retina surgery to preserve vision.
Dry eye and allergies
Though having dry eyes won’t necessarily impact your vision, it can be a painful condition that affects your quality of life. Medicare will generally cover an exam to diagnose the problem since it’s not considered “routine,” at which point you’ll be on the hook for 20 percent coinsurance on top of your Part B deductible. Your Part D plan might also cover medication to treat the condition, though in some cases, over-the-counter treatment will suffice. You’ll get similar coverage with a Medicare Advantage plan, and Medigap can help with your out-of-pocket costs.
Like excessive dryness, eye injuries aren’t considered “routine,” and are therefore eligible for coverage under Medicare, subject to the usual 20 percent coinsurance and deductible that Medigap can help with. Medicare Advantage will cover treatment for eye trauma as well.
Don’t get shortchanged
Knowing what vision services you’re entitled to under your Medicare coverage will ensure that you get the care you need. Though Medicare won’t pay for routine eye care, it will pay to diagnose and treat a number of dangerous conditions that could compromise your vision.
Additionally, health advocates are currently in the process of pushing for increased vision coverage under Medicare so that seniors don’t neglect their eye health due to cost.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.