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Vision Insurance
VSP Contributor, 20 Feb 2024

Does Medicare Cover Eye Exams and Vision Care?

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Introduction

As we age, taking care of our eyes becomes increasingly important. Regular eye exams are crucial for maintaining good vision and catching potential issues early. For many older adults, Medicare is a lifeline for healthcare coverage. But does Medicare cover vision care? In this article, we'll explore the ins and outs of Medicare regarding eye exams and vision care, shedding light on what's covered, what’s not covered, and what Medicare alternatives are available.

Medicare and Eye Exams

Medicare, the federal health insurance program for individuals aged 65 and older, plays a vital role in ensuring access to essential healthcare services. When it comes to eye exams, it's important to understand that there are different types of eye exams and they are offered by various eye care professionals. We’ll also learn that Medicare covers only certain aspects of eye exams.

Types of Eye Exams and Eye Doctors:
Eye exams come in different forms, such as routine eye exams, dilated eye exams, and glaucoma tests. Optometrists, ophthalmologists, and opticians are all eyecare practitioners, but they differ in their education and level of care they provide.

An Ophthalmologist provides medical and surgical treatment of eye conditions.
An Optometrist provides eye care, such as a yearly comprehensive eye exam or refilling an eyeglass, contact lens, or eye medication prescription. They also can take care of other eye-health related needs between yearly exams and provide early detection of many systemic health conditions.
An optician works at your local Optometrist’s office or vision care center and can help if you need an eyeglass or contacts prescription filled or adjusted.

If you're looking for an eye doctor, VSP offers flexible coverage to help you find the eye care you need, when you need it. VSP has the largest network of independent doctors, and network doctors always accept new VSP patients.

What Vision Care Does Medicare Cover?

Medicare generally covers only certain eye exams, specifically those related to the diagnosis and treatment of eye diseases. This means routine eye exams for glasses or contact lenses are not covered by Original Medicare (Part A and Part B). However, in your first year of having Medicare Part B, a basic vision test is included with your “Welcome to Medicare” initial preventative visit. For other types of eye exams, you may consider a separate vision plan.

Vision Care for Those with Diabetes:
Medicare Part B does offer an annual diabetic eye exam. Just make sure it's done by a qualified eye doctor. Your Part B deductible, plus additional copays may be required.

Medicare and Vision Care
Understanding the scope of vision care benefits (beyond eye exams) covered by Medicare is essential for making informed decisions about your eye health. Let’s look at the details of what Medicare offers for vision and eye care.

Types of Vision Care Included with Medicare:
Medicare covers vision care that is deemed medically necessary. This includes services related to the diagnosis and treatment of eye diseases, such as cataracts, glaucoma, diabetic eye diseases, and macular degeneration. Medically necessary procedures, like cataract surgery, are typically covered.

More About What Medicare Covers for Vision Care

Glaucoma Testing:
Are you at high risk for glaucoma? Medicare Part B covers a glaucoma test every 12 months. High-risk factors include age, race, a family history of glaucoma, corticosteroid use, and certain medical conditions such as diabetes, high blood pressure, and heart disease. Your cost is a 20% copayment after meeting the Part B deductible.

Macular Degeneration Testing:
Dealing with age-related macular degeneration? Medicare Part B may assist with tests and treatment associated with macular degeneration. Your responsibility? A 20% copayment after meeting the Part B deductible.

Cataract Surgery:
Medicare offers coverage for cataract surgery. Medicare Part B will cover medically necessary cataract surgery, traditional or laser. Your costs include a 20% copayment plus additional out-of-pocket expenses, like deductibles and medication fees.

Contacts and Eyeglass Coverage:
Medicare doesn’t cover routine vision correction, including eyeglasses. However, if you undergo cataract surgery and get an intraocular lens (IOL), Medicare Part B pitches in for one set of corrective lenses. After the Part B deductible, you pay a 20% copayment.

Alternatives to Medicare for Vision Coverage

With the current limitations of Medicare in covering annual eye exams and glasses, it’s crucial to explore additional coverage options. These private plans can provide the extra coverage needed for comprehensive vision care. Here are a few options available to boost your vision and eye care coverage.

Medicare Advantage Vision Coverage:
Medicare Part C, also known as Medicare Advantage plans, may offer additional vision benefits and coverage. These plans are offered by private insurers approved by Medicare and can provide benefits beyond what Original Medicare covers.

Medicare Supplement Vision Coverage:
To enhance your Medicare benefits, some people add a Medicare Supplement (Medigap) plan to their Original Medicare. Some Medigap plans may offer limited vision benefits, such as coverage for routine eye exams and eyeglasses. However, the availability of these vision benefits can vary depending on the specific Medigap plan you choose. Be sure to carefully review the coverage options and compare different Medigap plans to find one that suits your vision care needs.

Stand-alone Individual Vision Plans:
With a private stand-alone vision plan, you’ll have the option to choose from several levels of benefits and different monthly premiums corresponding to the level of coverage. Stand-alone plans offer a good value and benefits to save you money, especially when you need to get eyeglasses or contacts. VSP® vision plans offer the benefit of a wide range of network professionals all over the country, and several plan options.

Conclusion

In conclusion, Medicare plays an important role in covering medically necessary aspects of vision care. Because regular eye exams are essential for maintaining overall health, it’s important to have an understanding of the limitations of what Medicare covers.

Staying informed about your vision coverage options and taking proactive steps, such as exploring private plans like the ones offered by VSP, can significantly contribute to your overall eye health. With the right knowledge and choices, you can enjoy clear vision and a brighter future.

Ready to look for a stand-alone vision plan? Get started today! Compare vision plans to find out which VSP Individual Vision Plans stand-alone plan is right for you and your family.*

*Check your Medicare Plan to see if your vision care needs are covered. And/or if a VSP Individual Vision Plans is right for you. VSP Vision Care does not coordinate benefits with Medicare.

Disclaimer: Information received through VSP Individual Vision Plans’ social media channels is for informational purposes only and does not constitute medical advice, medical recommendations, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Reviewed by Dr. Valerie Sheety-Pilon:

Does Medicare Cover Eye Exams and Vision Care? Dr. Valerie Sheety-Pilon is Vice President of Clinical and Medical Affairs at VSP Vison Care where she helps drive strategic initiatives aimed at raising awareness about vision, eye health and its connection to overall wellness, while providing insight into medical advancements that seek to benefit patient care. She also provides oversight of VSP programs to address gaps in care for some of the most high-risk populations, including those living with diabetes.
With more than two decades of experience as a Doctor of Optometry, Dr. Sheety-Pilon has dedicated much of her time to clinical research across numerous ophthalmic subspecialties and has an established history of helping patients through novel therapeutic agents and clinical adoption of transformative technology in the areas of digital health, pharmaceuticals, and medical devices.

Prior to joining VSP Vision in 2019, Dr. Sheety-Pilon served as Adjunct Clinical Professor at Illinois College of Optometry, held various executive positions within the eye health industry, and has extensive experience managing and practicing within an ophthalmology and optometry practice.