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Medicare & Eye care: 5 Things Beneficiaries Should Know

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 Vision problems can become a common issue many will deal with as they get older. As a Medicare beneficiary you may be wondering what type of vision services you’re covered for.

Original Medicare:  Original Medicare, Part A and Part B, does not cover routine eye exams for eyeglasses or contact lenses. Medicare will only pay for routine eye care in the following specific circumstances:

  • If you have Diabetes: Medicare will pay for an eye exam once every 12 months to check for eye disease due to the condition.
  • If you are at risk for Glaucoma: Medicare will cover an eye exam by a state authorized eye doctor once every 12 months. You are considered high risk if you have:
    • Diabetes
    • A family history of glaucoma
    • Are African American aged 50 or older
    • Or are Hispanic and age 65 or older

Medicare will however pay for some eye care services if you have a chronic eye condition such as cataracts, glaucoma or age related macular degeneration (AMD). In the case of those conditions Medicare will cover:

  • An eye exam to diagnose a potential vision problem. If you have a vision problem that may indicate a serious eye condition Medicare will pay for an exam to try and diagnose the problem, even if the results come back that there is nothing wrong with your eyes.
  • Surgical procedures to repair eye function due to cataracts or glaucoma.
    Example: Medicare will cover surgery to remove cataracts and replace your eye’s lens with a man made intraocular lens.
  • Eyeglasses or contacts only in the event that you have had cataract surgery in which your eye’s lens was replaced with an intraocular lens. Medicare covers a standard pair of unintended prescription eyeglasses or contact lenses if you are in need of them after surgery.
  • Medicare may pay for customized eyeglasses or contacts, but only if deemed medically necessary.

 Some Medicare Advantage plans may offer additional benefits, which can include routine vision care.  To make sure that you have proper coverage you need for vision related issues call one of our trusted professionals today.

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