Millions of Americans experience vision problems, and this number continues to rise as the population ages. It’s estimated that 3.4 million people in the US over age 40 are legally blind.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 eye care 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. 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.
Why Eye Care is Important for Older Adults
It’s important for all adults to consider regular vision care, but especially older adults. As you age, your risk of developing conditions that affect your vision increases. A 2023 study found that more than 25% of adults in the US age 71 and older have some form of visual impairment.
Vision problems can negatively impact your overall health and quality of life. However, seeking regular eye care can help you catch vision problems earlier, lessening the severity or helping you avoid them altogether. The American Optometric Association recommends annual eye exams for everyone over age 60.
Have questions about your Medicare Advantage coverage? Let SelectQuote help.
If you have questions about Medicare coverage for vision care, we can help. SelectQuote’s experienced licensed insurance agents can quickly and easily search Medicare Advantage and Supplement plans, comparing benefits and costs to make the enrollment process easier for you. We’ll help you find the right coverage for your situation so you can stay healthy and protected.
