Does Medicare cover vision? Choosing the right Medicare plan for you can have its complications, but Senior Solutions Group is here to help you feel more comfortable in your decisions. Here are 6 things you need to know regarding Medicare and vision coverage to help you best understand the process of choosing a Medicare plan.
Does Medicare Cover Vision? 6 Things You Need to Know
1. Original Medicare Does Not Cover Routine Eye Examinations
Original Medicare includes both Part A (hospital insurance) and Part B (medical insurance). This is a fee-for-service plan, meaning Medicare will typically pay an approved amount of the costs rendered by some health care providers, and then the enrolled would be responsible for the rest.
With routine eye care, a person with Original Medicare is responsible for all costs. A routine eye examination, or eye refraction, includes the testing performed by an optometrist to determine your eyeglass prescription. Likewise, if you have Original Medicare, there are typically no benefits toward glasses and contact lenses.
As with most things insurance, however, there is always an exception.
2. Original Medicare May Help Pay for Glasses After Cataract Surgery
Most people will experience cataracts in their lifetime. With cataracts, the eye’s lens becomes cloudy, often creating blur that glasses or contact lenses can not correct. You may also experience difficulty driving at night and haloes around headlights.
When cataract surgery becomes necessary, an ophthalmologist removes the cloudy lens and replaces it with an implant. With basic covered surgery, this implant will often correct distance vision; however, glasses for reading would then still be necessary. There are recent advancements that can allow for intraocular lenses to correct both distance and near vision. These lenses come at an extra cost that is likely not covered by Medicare.
Original Medicare does help pay for one pair of glasses or one set of contact lenses following cataract surgery. This is true even if you have cataract surgery on only one eye. But expect costs to increase with upgrades such as no-line bifocals, premium no-glare coatings, or a pricier frame. An optician will best assist you in determining what your insurance allows.
3. Original Medicare May Help Pay for Medical Eye Examinations
If you have cataracts or another condition that may pertain to the eye, Medicare Part B provides some coverage for the testing and monitoring of these medical diagnoses. Here are some common conditions you may experience where Original Medicare will provide coverage for annual monitoring:
Diabetes
If you are diabetic, your primary care provider has likely already expressed to you the importance of annual eye exams. Elevated blood sugar can have significant effects on vision and overall health, which often first presents in the eye.
With dilated eye examinations, your optometrist or ophthalmologist can examine your retina to determine if you have any signs of diabetic retinopathy in the form of small hemorrhages or microaneurysms. Through further testing with devices such as an Ocular Coherence Tomography (OCT), a non-invasive imaging test, your eye doctor can also detect if there is any fluid in the macula, which can then lead to blindness if not treated properly.
Because of these risk factors, annual eye exams are a necessity to your overall health, and Medicare provides some coverage for these appointments.
Macular Degeneration
Macular degeneration is the leading cause of vision loss. This condition presents as either dry or wet. In the dry form, the center point of the retina, the macula, deteriorates beneath a build-up of deposits, leading to central vision loss. There is no treatment for dry macular degeneration, however, exercise and eating well can slow down the process.
If dry macular degeneration becomes wet, this means that leaky blood vessels have grown beneath the retina and may be of serious concern. Often ophthalmologists will treat wet macular degeneration with injections in the eye itself.
Because these injections are administered by the ophthalmologist in office, you may have some coverage with your Medicare Part B plan, which provides some benefits toward medications administered by health care providers in a hospital or medical office setting.
Posterior Vitreous Detachment
As we reach our 60s, a condition many will experience is posterior vitreous detachment or PVD. As we age, the bag of fluid inside of the eye, once gel-like, eventually liquefies and pulls away from the retina.
This process may be alarming to many people who experience flashes of light or floaters in their vision because of the tugging on the retina. While often these symptoms are harmless, it is very important to follow up with your optometrist or ophthalmologist as soon as these flashes and floaters appear.
This is because some PVDs can lead to tears or detachments of the retina. Dilation or retinal imaging is necessary to determine if this has occurred, necessitating immediate treatment.
Glaucoma
The eye is like a sink. Fluid goes in and must come out, however, sometimes the sink does not always work as it should. Often there is a problem with the drain, and other times the issue lies with the faucet. Either way, the build-up of liquid in the eye can then lead to too much pressure on the optic nerve, causing irreversible damage.
If left untreated, this damage can show symptoms of tunnel vision and then eventually blindness. In the early stages of glaucoma, there are no visual side effects, which is why annual eye examinations are so important in order for an eye professional to catch the condition and treat it, typically with daily eye drops before it escalates. Monitoring for glaucoma progression may include an OCT or visual field testing, which, with a diagnosis, will have some coverage from Original Medicare.
You do not always need to have a glaucoma diagnosis in order to receive some coverage with Original Medicare, however. In fact, those of high risk, including African Americans over the age of 50, have access to coverage with Medicare toward annual glaucoma testing and monitoring. With intraocular eye pressure measurements, optic nerve monitoring, and family history intake, your doctor will determine if you possess any risk factors of this condition.
4. Medicare Advantage May Help Pay for Eye Drops
It is important to note that if you do develop glaucoma, or any other eye condition requiring prescription medications, Original Medicare does not provide coverage. This means that having a condition such as glaucoma, where eye-drop treatment is often a necessity for preventing blindness, means more out-of-pocket costs.
Medicare Advantage is a combination of Part A, Part B, and often Part D. While Part A and B provide some coverage for medications administered by a health care provider, such as injections to treat wet macular degeneration, Part D is a prescription drug plan that may provide more coverage for self-administered medications that you would pick up from the pharmacy.
Some Medicare Advantage plans may also include Part C, which then could provide some vision benefits as well as prescription, dental, and hearing coverage. However, this too is varying, as all plans differ, so it is important to be aware of what Advantage plan you are selecting based on what is available through your licensed insurance agency.
5. Medigap May Help Fill Some “Gaps”
Another form of Medicare you might consider is called Medigap. Medigap often helps to fill the gaps where Original Medicare and Medicare Advantage lack. Medigap is a supplemental insurance to Medicare that can help cover costs of copayments, coinsurance, and deductibles.
Medigap policies still do not typically provide vision coverage: however, they may assist in costs of the treatment of medical eye conditions. A Medigap policy can be purchased from any licensed insurance agency in your area, and from there you can determine if this is right for you.
6. Consider a Vision Supplement Plan
You may have heard of common vision insurance plans such as Eyemed or VSP. Just as with dental care, vision also has separate insurance plans that can provide the most coverage for routine eye care, glasses, and contact lenses. This would come with additional monthly costs but may help you save with your annual visits.
Again, you can speak with your insurance agent to determine what plans are available to you. It is also important to note that not all eye professionals accept every form of vision insurance, but you can verify this also with your insurance agent or before scheduling your appointment.
Get More Help
There is no overestimating the importance of routine eye care, not only to correct blurred vision with glasses or contact lenses but to remain in the best overall health. Many precursors to underlying medical conditions can first present in the eyes. This is often true of diabetes, hypertension, and sometimes even cancer.
While the world of Medicare may feel daunting and complicated when you have a question like does Medicare cover vision, a better understanding of your Medicare insurance coverage allows you to best prepare for what expenses may come along. For more assistance, visit Senior Solutions Group today!
