Coffee & Coverage: Medicare and Vision Care

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Medicare doesn’t typically cover vision care services like routine eye exams. Medicare doesn’t cover eyeglasses or contact lenses either, except under certain circumstances. While regular vision exams are important as you get older, vision benefits vary depending based on the type of plan you have.

Medicare Part A 

Medicare Part A is hospital insurance and only covers vision care when the vision condition is considered a medical problem like a medical emergency or traumatic injury; for example, vision care is covered when the beneficiary must be admitted to the hospital. Medicare Part A does not cover routine vision exams and eye refractions though.

Medicare Part B

Medicare Part B is medical insurance and will cover some vision care. You’re not covered for vision correction like eyeglasses or contact lenses under Medicare Part B unless you need vision correction after cataract surgery. The following are the cases in which Medicare will cover vision care:

  1. Glaucoma. Glaucoma causes damage to the optic nerve and, eventually, reduced peripheral vision. Medicare Part B covers annual glaucoma screenings for people who are considered high risk. High-risk means those with glaucoma in their family history, African Americans age 50 and older, Hispanic Americans age 65 and older, and people with diabetes. Medicare only covers yearly vision screenings for glaucoma performed by state-approved vision care specialists. You pay your 20 percent Medicare coinsurance for the vision care costs approved by Medicare.
  2. Cataracts. Medicare Part B vision benefits will cover cataract surgery. Cataracts occur when the lens becomes cloudy and vision is blurred. Medicare will cover the cost of the artificial lens you would need to replace the lens that is affected by cataracts. Medicare will also cover the cost for vision correction products, such as glasses with standard frames, following cataract surgery.
  3. Eye Prosthesis. Medicare Part B vision benefits will cover eye prostheses for absence or shrinkage of the eye due to birth defect, trauma, or surgical removal. It covers the polishing and resurfacing of vision prostheses twice a year, as well as one size adjustment of the prostheses without documentation. Additional enlargements or reductions are only covered when medically necessary. Medicare covers the cost for vision prosthesis replacement if the vision prosthesis is lost, stolen, or damaged within the first five years.
  4. Macular degeneration. Medicare will cover testing and treatment for age-related macular degeneration. Macular degeneration is a common disease as your age in which you experience vision loss in the center of your eye.  
  5. Diabetes. If you have diabetes, an annual screening for diabetic retinopathy is covered by Medicare Part B. Retinopathy is a complication of diabetes in which the blood vessels of the eye become damaged. It can eventually lead to blindness if not treated properly.  
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Medicare Part C

Medicare Part C, also known as Medicare Advantage, plans are offered by private, Medicare-approved insurers. All private insurers must offer at least the same benefits as Original Medicare but may include other benefits. These other benefits can include routine vision, routine dental, and Medicare prescription drug coverage. 

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