Vision Care for Seniors: What’s Covered
This article was updated on: 09/15/2018
According to the Centers for Disease Control and Prevention (CDC), the prevalence of blindness and vision impairment increases rapidly with age among all racial and ethnic groups. The problems are the worst among people older than 75. Vision impairment could be caused by diabetic retinopathy, glaucoma, cataracts, and/or age-related macular degeneration. According to the CDC, vision care may help correct 50% of vision problems. Read more to learn what Medicare coverage you can get for vision care.
Medicare-covered vision services
Medicare typically doesn’t cover vision care services such as routine eye exams for eyeglasses or contact lenses. Generally Medicare doesn’t cover eyeglasses or contact lenses either, except in certain circumstances. Medicare Part B (medical insurance) does cover some preventive and diagnostic exams.
- If you have diabetes, Medicare will generally cover a yearly eye exam for diabetic retinopathy. Diabetic retinopathy is caused when high blood sugar levels cause damage to blood vessels in the retina (the layer of nerve cells lining the back wall inside the eye), according to the American Academy of Ophthalmology (AAO). For this exam you generally pay 20% of the Medicare-approved amount for the doctor’s services and the Part B deductible applies.
- All beneficiaries who are at risk for glaucoma are covered for a glaucoma test once every 12 months. According to the AAO, glaucoma is a disease that damages the eye’s optic nerve. This usually happens when fluid buildup causes pressure in the eye. Medicare considers you at risk for glaucoma if you have diabetes, a family history of glaucoma, are an African American age 50 or older, or a Hispanic American age 65 or older. You generally pay 20% of the Medicare-approved amount for this exam and the Part B deductible applies.
- Medicare may cover some people who have age-related macular degeneration (AMD), including treatment with certain injected drugs. According to the American Academy of Ophthalmology (AAO), macular degeneration causes a loss of central vision while peripheral vision may still be normal. This condition is caused when a part of the retina called the macula is damaged. You generally pay 20% of the Medicare-approved amount for the prescription drugs and the doctor’s services, and the Part B deductible applies.
- According to the American Academy of Ophthalmology, cataract surgery is an operation to remove the eye’s lens when it is cloudy. While Medicare usually doesn’t cover eyewear, in the case of a cataract surgery that implants an intraocular lens, Medicare Part B generally helps cover corrective lenses, either a pair of eyeglasses or a set of contact lenses. Typically, Medicare will only pay for contact lenses or glasses provided by a supplier that accepts Medicare assignment. You must generally pay 20% of the Medicare-approved amount plus the Part B deductible.
Coverage for routine vision care
To get routine vision coverage, you may be able to enroll in a Medicare Advantage plan. The Medicare Advantage program (sometimes called Medicare Part C) is another way to get your Medicare Part A and Part B benefits (except for hospice services, which are still covered under Part A), and Medicare Advantage plans often offer extra benefits, like routine vision coverage. Some Medicare Advantage plans may cover vision care such as yearly routine eye exams, eyeglass lenses and frames, and contact lenses. A Medicare Advantage plan must also cover all the vision services that Original Medicare covers. Keep in mind that with Medicare Advantage, you must continue to pay your Part B premium and that not all plans may be available in your area.
Ophthalmologists, optometrists, and opticians
You may need different types of eye care, and this may be provided by various types of vision specialists. Ophthalmologists are medical doctors who specialize in eye and vision care, according to the American Academy of Ophthalmology. Optometrists conduct vision tests and some related screenings, but they are not medical doctors. Opticians are specialists who fit your prescriptions to eye glasses or contact lenses. They do not treat eye diseases.
Depending on your needs, you may see one or all three of these health-care providers. Always confirm whether or not the provider accepts Medicare assignment first so you are better aware of what your costs may be. If you have a Medicare Advantage plan, you might want to see an eye-care specialist in the plan’s provider network (if applicable).
Do you have other questions about Medicare coverage for vision? Would you like to find a Medicare Advantage plan that provides more routine vision coverage than what you currently have? I would be more than happy to help you with that. You can use the links to schedule a phone call or request an email containing personalized plan information. If you want to start by browsing plans in your area on your own, just hit the Find Plans button on this page.