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Original Medicare does not cover basic eye exams. This doesn't mean, however, that there is no Medicare vision coverage. Medicare eye exams are covered when the exam has a specific medical reason.
What Does Medicare cover?
Medicare eye coverage does not extend to covering eye glasses - with one exception. They will cover basic frames and lenses after cataract surgery. This usually only occurs once between each separate eye surgery. You pay 20 percent of the Medicare approved amount for the cost of the glasses.
There is Medicare eye surgery coverage in some cases, Medicare does cover a number of procedures and screenings of a medical nature. If you have dry eye syndrome or blephartis (inflammation of the eyelash follicles), for instance, Medicare pays for treatment and doctor visits. Also, for just over a decade, Medicare has covered Glaucoma for those most at risk, including:
- People with diabetes.
- People with a family history of glaucoma.
- African-Americans over the age of 50.
- Hispanics over the age of 65.
These screenings include a dilated exam with intraocular pressure measurement, a direct ophthalmology exam, or a slit-lamp biomicroscopic exam. These tests must be conducted by an eye doctor who is registered to practice in your state.
One medical condition of the eyes that afflicts seniors is macular degeneration. This condition is most prevalent among those over 50. Each forms (wet and dry) can lead to the retina becoming detached and blindness. Original Medicare does sometimes cover a treatment for macular degeneration. The treatment is ocular photodynamic therapy with verteporfin. Medicare covers 80 percent and you pay the remaining 20 percent after you have paid your Part B deductible. Ask your Medicare provider for the specific details of your coverage.
If you have a different vision problem that seems to be part of a serious medical condition, Medicare may pay for an exam. If you have other medical vision problems, beyond routine eye exams or glasses, you should check with your provider or contact Medicare directly. This is especially true if you feel you have one of the four disorders that most afflict seniors: cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy.
Medicare Advantage Plan Coverage
You may also find that your Medicare Advantage Plan covers some vision related costs. Medicare Advantage Plans, also called Medicare Part C, are similar to an HMO or PPO. They include Medicare Part A & B (hospital and medical insurance) and usually Part D drug insurance. It should not be difficult to find out which companies offer vision coverage and which do not.
Check these costs versus buying a plan unrelated to Medicare. Also look at the benefits. Standard eye exams and eye glasses are not exorbitantly expensive compared to other medical expenses. Check to see what an exam and a pair of eyeglasses costs in your area without insurance as a point of reference.
Medigap Plan Coverage
Medigap plans can also cover vision. Medigap plans are designed to cover the gaps in Original Medicare. You cannot purchase a new Medigap plan if you are currently enrolled in a Medicare Advantage Plan.
There is no required coverage in any of the standard lettered Medigap plans. Insurers can offer additional coverage, which can include vision. Congress allows Medigap plans, like Advantage Plans, to offer additional coverage that is "new and innovative." This can refer to vision coverage. Some insurers provide additional eye and vision coverage for extra costs. Be aware that not all Medigap insurers offer vision.
Seniors who do not take proper care of their vision increase their risks for other medical problems:
- If you cannot see you are more likely to suffer an injury during a fall.
- If you are on medications you might take the wrong pill at the wrong time or be unable to clearly read instructions.
- It is harder to get around and take care of yourself if your vision is impaired.
- Seniors who have vision loss are more likely to become depressed. Lighthouse International, an advocacy group for those with impaired vision and blindness states on their website that, "an estimated one-third of older adults with vision loss report clinically significant depressive symptoms."
The Center for Disease Control notes that people who have an Age Related Eye Diseases (AREDS) often are at risk for multiple diseases. These diseases are "common and costly" for Medicare particularly. Cataract treatment alone accounted for 60 percent of Medicare's eye care cost in the 1990s. They also note that the magnitude of the problem is not understood completely because it is hard for the CDC to accurately measure vision loss or even blindness using common methods.
Find out what sort of vision coverage is available to you and compare costs. Original Medicare may cover less than employer coverage but other plans, such as Medigap and Medicare Advantage Plans, may be of assistance.