Understanding Medicare Vision Coverage

If you are just starting Medicare coverage or plan to start soon, you may wonder what type of vision services are reimbursed. Medicare insurance coverage can be somewhat complicated, especially when it comes to eye care. In this article we examine circumstances when Medicare covers vision services and what to expect from alternatives to Medicare Part A and B, including Medicare Advantage plans.

Understanding Medicare Terms 

Before learning about Medicare and vision coverage, it's important to understand a few basic Medicare terms. The federal government divides Medicare into four parts, including the following:

Medicare Part A: Medicare Part A covers inpatient hospital stays and includes services such as nursing care, medications while inpatient, labs, and imaging while inpatient. This may include an inpatient stay due to some forms of eye surgery. Part A and B are called Original Medicare.

Medicare Part B: Medicare Part B covers various medical services a person may receive as an outpatient, such as doctors' visits, health screenings, and durable medical equipment.

Medicare Part C: Medicare Part C is also known as Medicare Advantage plans. These plans are optional coverage that replaces Medicare Part A and Part B. The federal government regulates Medicare Advantage plans, which means the coverage offered is similar to what Medicare Part A and B cover. However, some Medicare Advantage plans offer more coverage, including vision services.

Medicare Part D: Medicare Part D covers prescription medications. Plans are purchased from private insurance providers. In some cases, Medicare Advantage plans combine prescription coverage within their plans. This coverage may include prescription eye drops deemed medically necessary.
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Does Original Medicare cover routine eye care? 

Original Medicare does not cover routine eye care such as eye exams. However, it will generally cover the cost of treating most eye diseases, such as age-related macular degeneration and glaucoma. This treatment may include surgery, inpatient hospital stays, and nursing care while inpatient. Some services related to eye care that treat eye diseases that require a hospital stay, such as surgery, are covered by Medicare Part A. Medicare Part B covers other services such as a follow-up eye doctor's office visit after eye surgery. 

Will Original Medicare pay for eyeglasses?

According to the Medicare.gov website, Medicare usually does not cover contact lenses or eyeglasses. However, there are exceptions. Medicare Part B usually covers one pair of eyeglasses or one set of contact lenses after approved cataract surgery.

When does Original Medical pay for eye exams? 

In addition to paying for treatment for most eye diseases, original Medicare also covers eye exams in the following situations:

• Part B generally covers eye exams for people with diabetic retinopathy once per year.
• Part B also covers glaucoma screening for individuals considered at high risk, such as those who have a family history or have diabetes.

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Do Medicare Advantage plans cover eyecare? 

Medicare Advantage plans vary in coverage. However, some plans offer vision care. Many Medicare Advantage plans typically cover vision care services such as a yearly exam; some may also cover eyeglasses. Similar to the original Medicare plan, Medicare Advantage plans also cover treatment for most eye diseases.

Keep in mind Medicare coverage can change from year to year. Additionally, Medicare Advantage plans may differ in their coverage. If you have questions regarding eye care coverage, you can contact your Medicare Advantage plan representative. For questions regarding eye care coverage for Original Medicare, visit Medicare.gov.

If you would like to ask whether an appointment with one of our eye doctors would be appropriate at this time, call our office at 508-746-8600.