As we get older, our vision tends to change. Often, this can mean that we either need to get glasses for the first time or adjust an existing prescription with a visit to an eye doctor. If you’re new to Medicare and need an eye exam, then you may be wondering, “Does Medicare cover eye exams?”

Are Eye Exams Covered Under Medicare

The simple answer to this question is no. Medicare health insurance does not cover the costs of eye exams. That means, if you have Original Medicare (Medicare Part A and Part B), you will need to pay the full costs of your visit to the eye doctor when you go to get an exam. However, certain Medicare Advantage plans include coverage for eye exams. If you have a Medicare Advantage plan with vision coverage, then the exact amount that you’ll pay will vary based on the details of your plan. Be sure to check with your provider if you’re unsure about your coverage for eye exams under Medicare Advantage.

Does Medicare Pay for Glasses in 2021

Medicare doesn’t cover the cost for eyeglasses in 2021. Unfortunately, you are responsible for paying 100% of the cost. The only way Original Medicare will pay for glasses is if you had cataract surgery. Then, Medicare Part B will cover the cost for one set of corrective glasses or contacts.

How Often Can You Get an Eye Test with Medicare?

Original Medicare does not cover eye exams. However, Original Medicare may cover eye exams and diagnostic test, if you have the following eye diseases or conditions:

  • Diabetes
    • If you have diabetes, Medicare covers an annual eye exam to check for diabetic retinopathy. Medicare Part B covers a good chunk of the costs of diabetic retinopathy once per year as long as you have diabetes, and see a doctor who’s legally allowed to perform the test. To receive this coverage, first you must meet your Part B deductible. Then, you’d pay 20% of allowable charges, and Medicare will pay 80%.
  • Glaucoma
    • You can qualify to have a large amount of the costs of one of the tests covered every 12 months if you’re at high risk for developing glaucoma. This means you must fulfill one or more of the following conditions:
      • Have diabetes
      • Have a family history of glaucoma
      • Be African American and age 50 or older
      • Be Hispanic and age 50 or older
    • If you satisfy the above conditions, and have met your Part B deductible, then you would be responsible for 20% of the allowable charges.
  • Macular Degeneration, Age-Related
    • Diagnostic eye exams and tests as often as the doctor believes it is medically necessary to stay on top of the issue. For each exam or test, you would pay 20% as long as you have already met the Part B deductible.

If you want a Medicare plan that covers eye exams, you should consider a Medicare Advantage plan or Medicare Part C. Medicare Advantage plans have to at minimum offer the same coverage as Original Medicare. Medicare Advantage plans are offered through private, insurance companies and have different rules from Original Medicare. This allows Medicare Advantage plans to offer additional coverage for things like eye exams, glasses and contact lenses. You may be responsible for a copayment or have to pay a certain percentage out-of-pocket depending on the plan you choose.

Does Medicare Cover Cataract Surgery?

Medicare covers cataract surgery. Medicare covers the removal of the cataract, basic lens implants and one set of prescription eyeglasses or contact lenses. Please keep in mind that Medicare only covers basic lens implants. Medicare won’t cover more advanced implants.

Does Medicare Cover Eye Injuries?

It’s very possible that you need an eye exam due to an injury to your eye. As a general rule, any eye injury that’s not considered routine may be covered under Original Medicare. Of course, you would need to make sure that you have met your deductible, then, you’d most likely be responsible to pay 20% out of pocket.

Does Medigap Cover Eye Exams?

Medigap also known as Medicare Supplement coverage will help cover the costs for the eye diseases and conditions mentioned above, however, routine eye exams are not covered by Medigap. A good general rule here is if Original Medicare (Part A and Part B) does not cover the service, then there’s a good chance Medigap will not help cover the service either. Eye exams are considered routine eye care. Routine eye is not a benefit covered by Original Medicare.

Also keep in mind, there are quite a few insurance companies that offer individual vision coverage plans. Usually, you can enroll in these policies any time of the year. Another option to consider is a Health Savings Account (HSA). This account allows you to take qualified withdrawals for pay for eye exams and glasses. What’s even better, if you’re 65 or older, you can even use your HSA money to pay your vision premiums.

How Do I Learn More About Medicare Eye Exam Coverage?

If you’d like to learn more about Medicare’s coverage for eye exams or more about what does Medicare cover, consider contacting Time for 65. Our partnered licensed agents are standing by to answer your questions and to provide you with personalized information about Medicare coverage and eye exams. Connect with someone now by either filling out this form or giving us a call.

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