Understanding Medicare Coverage For Eyes and Vision

Understanding Medicare Coverage For Eyes and Vision

The risk for vision loss or developing optical impairments as you age becomes much greater. To maintain healthy vision and prevent vision problems from occurring later in life, it’s important to be proactive.

Having routine eye exams once every couple of years, or as often as your healthcare professional recommends, is key to maintaining the most optimal vision health possible. Did you know about half of all blindness is preventable with proper treatment and early detection?

Medicare beneficiaries who are diagnosed with a variety of diseases, or those at risk of disease development, are covered for several vision-related services. Having a proper understanding of benefits will help get the care you need to prevent potential eye issues. In this article, you’ll learn exactly what Medicare covers for various eye health and vision conditions. 

Preventative visit

The “Welcome to Medicare” preventative visit is a one-time introductory visit that you can use only within the first 12 months of becoming a Medicare beneficiary.

During this visit, you can talk with your healthcare provider on how to maintain healthy vision and get up-to-date screenings.

What to expect during the “Welcome to Medicare” preventative visit:

  • Your doctor will evaluate and document your medical and family medical history
  • Evaluation of current health conditions
  • Discussion of current prescriptions
  • Basic vision exam (screening for vision loss risk factors NOT done through dilated pupil)
  • Your doctor will set up any preventative screenings or services you may need
  • Your doctor may order additional tests depending on the history of your general and medical health
  • Before leaving the visit, you’ll receive a list or plan from your doctor with screenings and preventative services that are needed. – don’t forget to ask about eye exams!

This visit is important for your healthcare provider. Not only to get a general understanding of your overall vision health but to help provide you with proper care and detect potential preventable vision issues.

Medicare coverage for regular eye exams

Generally, Medicare does not cover the cost of routine eye exams. However, there are exceptions to this rule. Medicare will help cover the cost of exams if you are diabetic or are at risk for glaucoma.

Keep in mind, Medicare does not cover eyeglasses or contact lenses, unless directly following a cataract surgery. Also, Medicare will cover eye exams for medical reasons like injury or disease.

Medicare Advantage Plans can help cover costs of routine eye care, deductibles, and other fees. Check with your eye care professional to determine what type of care and services you need to determine if your Medicare Advantage Plan will cover them.

There are stand-alone dental, vision, and hearing plans that can supplement your Medicare benefits. You can actually enroll in multiple dental plans and stack those benefits, some restrictions apply.

RELATED: The Nitty Gritty Dental Insurance Plans

This is what vision with glaucoma looks like.

Glaucoma

Glaucoma is one of the leading causes of blindness for individuals over the age of 40, claiming the sight of about 2.7 million Americans. Often, there’s no warning signs or symptoms. However, if detected early, there’s treatment available.

Medicare provides coverage for yearly glaucoma screenings for beneficiaries that are at high risk for development. Medicare will also cover many treatment options for glaucoma, this includes any surgery and/or prescription medications.

So, what determines a person is at high risk?

  • Having a family history (sibling or blood parent) of glaucoma
  • If you are African American and over 50 years
  • If you are Hispanic and 65 years old

Glaucoma exam coverage includes:

  • Dilated eye exam
  • Direct ophthalmoscopy
  • Intraocular pressure measurement
  • Visual acuity

This is what diabetic retinopathy looks like.

Diabetes

Having diabetes will put you at risk for developing many health concerns. Diabetic eye disease can impact anyone who has diabetes.

Some serious risk factors are:

Like glaucoma, often there’s no warning signs or symptoms. It’s important to keep up with routine eye exams to detect or prevent vision impairments.

Medicare beneficiaries who have diabetes will automatically qualify for the annual screening as mentioned above. Beneficiaries are entitled to receive an eye exam that checks for both glaucoma and diabetic retinopathy.

Cataracts vary in appearance and tend to increase in size with age.

Cataract surgery

Millions of Americans will suffer from cataracts every year, as this is another leading cause of blindness. In the U.S., one of the most commonly performed surgical procedure for those ages 65 and older is cataract surgery.

Medicare provides beneficiaries with two options for cataract surgery:

  1. IOL (basic lens replacement)
    • Multiple IOLs (to correct both far and nearsightedness)
      • Medicare pays in full up to $2,000
      • OR apply that same credit to new replacement lenses (multiple IOLs)
  2. Cataract removal

Beneficiaries are responsible to pay the difference (if any) after Medicare benefits are applied. Medicare will cover corrective eyeglasses or contacts following cataract surgery with an implanted intraocular lens.

Again, Medicare covers 80% of the Medicare-approved amount for ONE pair of eyeglasses or contact lenses after each surgery. Unless the beneficiary has a Medicare Supplement Plan, they’re responsible for additional charges if they choose to upgrade their frames.

This is what both wet (exudative) and dry (non-exudative) macular degeneration look like.

Macular Degeneration (AMD)

Macular degeneration is a disease that destroys central vision. This is a progressive disease that, like the others when left untreated, can cause severe vision loss and blindness. AMD claims the quality of vision for more than 2 million Americans ages 50+, being another main cause of blindness for people 50 and older.

Treatments are covered 80% through Medicare Part B for beneficiaries with Age-Related Macular Degeneration. Treatments include many medications or alternatives; talking with a Medicare agent can you help discuss treatments covered under your plan.

Medicare enrollment period changes

Enrollment periods will be changing in 2019 with the return of the Medicare Open Enrollment Period for Medicare Advantage beneficiaries. This enrollment period is for those beneficiaries who enrolled in a Medicare Advantage Plan that they’re not happy with.

During this time frame, Medicare Advantage beneficiaries can either switch to another Medicare Advantage Plan or switch back to Original Medicare and enroll in a Medicare Supplement Plan instead.

Annual Medicare Enrollment Periods are as followed:

  • Annual Enrollment Period: October 15th – December 7th
  • Medicare Open Enrollment Period: January 1st – March 31st

Remember, Medicare only covers 80% of your medical services. If you have secondary insurance, such as a Medicare Supplement Plan, that will cover the 20% remaining after Original Medicare pays their portion. Otherwise, you’re responsible for the remaining 20% as well as deductibles, coinsurance, and co-payments.

Lastly, if you have any further questions or need help deciding what option is best for you, seek advice from a licensed Medicare agent.

 

LEAVE A REPLY