Millions of Americans experience vision problems and this number continues to rise as the population ages. In fact, a study by the National Institutes of Health indicated that by 2050, the number of Americans with a vision problem could hit more than 8 million people.1
If you’re on Medicare and experience vision problems, you may be wondering about your coverage for eye exams and vision care. The risk of vision loss increases with age so it’s important to know that routine eye exams are not covered by Basic Medicare (Parts A and B). Let’s look at what exactly is covered by Medicare vision plans and what else you should know about your coverage on Medicare.
Does Medicare cover eye exams?
Medicare Part A (also known as hospital insurance) does not cover eye exams or vision unless the treatment takes place during hospitalization. For example, if you experience trauma to the eye and go to the hospital, Medicare Part A will likely cover your treatment. However, a regular contact or eyeglasses exam would not be covered.
Medicare Part B also doesn’t cover routine eye exams, but it does cover some diagnostic and preventative tests, including:
- Annual eye exams for individuals with diabetes to screen for diabetic retinopathy.
- Glaucoma testing every 12 months for those at high-risk for the disease. This typically includes those with diabetes, a family history of glaucoma, African Americans who are 50 or older and Hispanics who are 65 and older.
- Medicare Part B may also cover the diagnosis and treatment of macular degeneration, including treatment with certain injectable drugs.
- Cataract surgery and glasses or contacts needed as a result of the surgery.
In each case, you’ll typically pay 20% of the approved Medicare cost, plus your Medicare Part B deductible and copay if applicable. It’s important to also make sure you’re receiving treatment from someone who is allowed to do the test in your state. This can make the difference between your exam or treatment being covered by Medicare or not.
How to Get Medicare Coverage for Eye Exams
Many people seeking vision coverage for routine visits opt for a Medicare Advantage plan (Medicare Part C). These plans provide an alternative to Original Medicare, but can include additional coverage such as routine vision or dental benefits, prescription drugs and more. Some plans have premiums as low as $0/month,2 and at SelectQuote, we can help you find the right Medicare vision plan for you.
When signing up for Medicare, or using your Medicare benefits, it’s important to understand what is and is not covered. Taking the time to better understand your coverage can be the difference between paying a lot out-of-pocket and getting the care you need covered.
SelectQuote can help you sift through the fine print and make sure you’re getting the coverage you need and the benefits you deserve. If you’re one of the millions of Americans experiencing vision problems, let us help you find a policy that meets your needs. The service is free and there’s no obligation to enroll.
2 This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048 ), 24 hours a day/7 days a week or consult www.medicare.gov.
SelectQuote is a licensed and certified representative of a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal. SelectQuote complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.