Does Medicare Cover Eye Exams?
While Medicare does not cover routine eye exams for patients seeking eyeglasses or contact lenses, Medicare will pay for certain vision exams if deemed medically necessary to treat a specific eye condition such as glaucoma or cataracts.
If Medicare covers your eye exam, you will likely face Medicare out-of-pocket costs such as deductibles and copays.
A Medicare Supplement (Medigap) plan can help cover your out-of-pocket Medicare costs for covered eye exams.
What Eye Exams Does Medicare Pay For?
The following types of eye exams may be covered under Medicare Part B (medical insurance):
Annual Eye Exams for Diabetics
Medicare will cover one yearly exam for diabetic retinopathy, as long as the test is conducted by an eye doctor who has been approved by your state.
If you receive the exam in an eye doctor's office, you can expect to pay 20% of the Medicare-approved amount of the exam after you meet your Part B deductible. If you receive the exam as an outpatient in the hospital, you can expect a copayment, too.
Glaucoma is a condition where increased pressure within the eye creates a loss of sight. Medicare pays for an annual glaucoma test for high-risk patients.
Your out-of-pocket costs for an eye exam for glaucoma include the Part B deductible and 20% of the Medicare-approved amount if you receive the test in a doctor's office. An additional copayment applies for hospital outpatients.
If you suspect you have cataracts — a condition that causes cloudiness in your lenses that leads to vision loss — Medicare will help pay for corrective surgery if it's deemed medically necessary.
What you pay depends on the setting. If it's an outpatient procedure, expect to meet your Part B deductible and pay 20% of the Medicare-approved amount for the procedure.
If you're admitted to the hospital, the Part A deductible and coinsurance will apply as well.
Macular Degeneration Exam
Macular degeneration is an age-related disease that is the leading cause of vision loss in the United States.1
You are responsible for paying 20 percent of the Medicare-approved amount for doctor's services and treatment drugs. Additionally, you must meet your Medicare Part B deductible before Medicare will begin paying its share.
The out-of-pocket costs for these services can add up quickly. A Medicare Supplement Insurance plan can help pay for some of these Medicare costs.
Medigap Plans Can Help Pay for Out-of-Pocket Medicare Eye Exam Costs
Medicare Supplement Insurance (Medigap) helps cover some of your Medicare out-of-pocket costs, such as the 20% Part B coinsurance you might face for covered eye exams and some of the treatments listed above.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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1 American Macular Degeneration Foundation. What is Macular Degeneration? Retrieved Oct. 2019, from www.macular.org/what-macular-degeneration.
Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.