Vision Care for Seniors: What’s Covered
This article was updated on: 06/11/2019
According to the Centers for Disease Control and Prevention (CDC), blindness and low vision in the United States are primarily caused by age-related diseases. These diseases include age-related macular degeneration, cataracts, diabetic retinopathy, and glaucoma. Medicare generally only covers limited vision services. It does not routine eye exams.
Why would I want an eye exam if I’m not going blind?
According to the Centers for Disease Control and Prevention, regular eye exams can help find diseases early and help preserve your vision.
Some people don’t realize they need vision correction until they put on a pair of glasses and see the world come into a clearer focus.
Does Medicare pay for eye exams?
Medicare Part B (medical insurance) generally only covers preventive and diagnostic eye exams for the following conditions:
Diabetes: If you have diabetes you are generally covered for tests for diabetic retinopathy once a year. Diabetic retinopathy affects the retina in the back of the eye, according to the National Eye Institute, and is the most common cause of blindness among working-age adults.
You generally pay 20% of the Medicare-approved amount and the Part B deductible applies.
Glaucoma: If you’re at high risk for glaucoma, Medicare Part B generally covers a glaucoma test every 12 months.
Glaucoma damages the eye’s optic nerve, which could result in vision loss or blindness, according to the National Eye Institute. One risk factor of glaucoma is blood pressure. Diabetes and a family history of glaucoma may make you at high risk for glaucoma, as well as being African American or Hispanic.
You generally pay 20% of the Medicare-approved amount and the Medicare Part B deductible applies.
Macular degeneration: Age-related macular degeneration is also known as AMD, according to the National Eye Institute. It causes damage to the macula, which allows you to see objects straight ahead. While AMD does not lead to complete blindness, it can interfere with your abilities to carry out simple everyday activities. Medicare Part B typically covers diagnostic tests for age-related macular degeneration.
You generally pay 20% of the Medicare-approved amount for the doctor’s services and your Medicare Part B deductible applies.
Does Medicare cover vision care beyond these three types of eye exams?
Original Medicare (Part A and Part B) typically does not cover:
- Contact lenses
- Routine eye exams
With Original Medicare, you may have to pay 100% for most eyeglasses and contact lenses, as well as routine eye exams.
Original Medicare may help pay for corrective lenses only after a cataract surgery with an intraocular lens. Typically, Medicare will only pay for contact lenses or glasses provided by a supplier that accepts Medicare assignment.
How do Medicare Advantage plans cover vision?
If you’re unsatisfied with Original Medicare’s coverage of eye exams and eyeglasses, you may find that a Medicare Advantage plan can offer more extensive vision coverage.
Medicare Advantage plans must cover all the hospital and medical benefits that Original Medicare covers (except hospice care, which is still covered by Medicare Part A). Medicare Advantage plans are also allowed to offer supplemental benefits, such as routine vision, routine hearing, prescription drug coverage, and even meal delivery and transportation to doctor appointments.
According to the Centers for Medicare and Medicaid Services (CMS), a Medicare Advantage plan may cover:
- One new pair of eyeglasses every two years
- Routine eye exams and other services not covered by Original Medicare
- Contact lenses
- Eyeglass frames and upgrades
You generally have to continue your Medicare Part B premium when you have Medicare Advantage. Also be aware that not all Medicare Advantage plans may cover vision care besides what Medicare Part A and Part B may cover.
To begin looking for a Medicare Advantage plan that covers vision, enter your zip code on this page.