As we age, our vision changes. And unfortunately, it’s usually not in the good way. It’s common that the older we get, the more likely we are to need eye care, and/or eye wear. Many individuals think these regular, annual exams would be covered under Original Medicare. This is not the case as not all plans, or areas of coverage, are the same. This is why it is very important to refer to your plan to know if you are covered, and if you are, what is covered.

Medicare only covers routine eye care in the following circumstances:

  • You have diabetes. Medicare covers an annual eye exam by a state-authorized eye doctor to check for diabetes-related vision problems.
  • You’re at high risk for glaucoma. Medicare covers an annual eye exam by a state-authorized eye doctor. Who is considered high-risk for glaucoma?
    • Those with diabetes
    • Individuals with a family history of glaucoma
    • African Americans ages 50+
    • Hispanic Americans ages 65+

Otherwise, it will be dependent on the plan you have.

As a reminder, there are 4 parts of Medicare.

  • Part A covers inpatient hospital coverage. When it comes to vision, Part A will only cover when the condition is considered a traumatic injury or medical emergency that requires the beneficiary to be admitted to the hospital. Medicare Part A does not cover routine vision exams, sometimes referred to as eye refractions. Beneficiaries must pay 100% of the cost unless they have other vision coverage.
  • Part B covers outpatient medical coverage. Some vision care may be covered in Part B, but your routine vision exams are not. Additionally, you are not covered for vision correction such as eyeglasses or contact lenses under Medicare Part B unless you need vision correction after cataract surgery. Again, be sure to double check your plan to be certain this is the case as not all plans in every state or county are the same.
  • Part C is an alternative benefit form to Original Medicare that offers extra benefits. Many of these plans have incredible vision benefits. Many Part C plans offer: Under a Medicare Advantage plan, vision benefits may include:
    • Preventive eye exams covered under Original Medicare
    • Routine eye exams
    • Eyeglasses (frames and lenses)
    • Contact lenses
  • Part D is prescription drug coverage. Usually these plans would only cover certain products related to vision care, like eye drops or medications prescribed by your doctor for vision.

 

If vision is a big concern of yours now or for the future, it is important to select a plan that will over anticipated needs when it comes to vision. If you are turning 65, or under the age of 65 with a disability or illness, and need help finding Medicare Advantage plans that will cover vision, give us a call!