Medicare and Vision Coverage

While Original Medicare does not cover routine vision exams, glasses or contact lenses, Medicare Part B may cover certain tests and treatments for serious eye conditions. But in those exceptions, you may still have to pay out-of-pocket for a copayment and any deductible.

These exams are generally allowed once per year under Medicare Part B if you qualify.

Your doctor or other health care provider may recommend you have these exams or related services more than once a year. If that’s the case, you may be responsible for some or all of the costs out of your own pocket.

Ask why they’re being recommended and if Medicare will cover them.

Medicare Part B covers an eye exam for diabetic retinopathy once a year if you have diabetes. But you must have the exam done by an eye doctor legally allowed to do it in your state.

Diabetic retinopathy is caused by damage to blood vessels in the retina which can be caused by high blood sugar levels associated with diabetes, according to the American Academy of Ophthalmology. It generally affects both eyes.

You will be required to pay 20 percent of the Medicare-approved price for your doctor’s services. Your Medicare Part B deductible also applies to the exam. If the exam takes place in a hospital outpatient setting you will also be responsible for a copayment.

Medicare Part B covers one glaucoma test every 12 months if you’re at high risk for glaucoma. The doctor who conducts the exam must be licensed to supervise glaucoma screenings in your state before Medicare will cover the cost.

Glaucoma can damage the optic nerve that connects your eye to your brain. It’s caused by high pressure inside the eye and can lead to blindness.

You will still be required to pay 20 percent of the Medicare-approved cost for the glaucoma test and your deductible will apply. You will also have to pay a copayment if the test is part of a hospital outpatient setting.

Medicare Part B may cover certain types of diagnostic tests and treatment for age-related macular degeneration (AMD). Coverage can include treatment with certain injectable drugs.

Macular degeneration, an incurable eye disease, is the leading cause of vision loss in the United States, affecting more than 10 million Americans, according to the American Macular Degeneration Foundation. It’s caused by deterioration of the center of the retina.

With Part B coverage, you will still be responsible for 20 percent of the Medicare-approved amount for your doctor’s services and any drug used to treat AMD. The cost will also be subject to a copayment if it’s performed in a hospital outpatient setting.

Medicare will also cover surgery, exams and treatment for certain eye conditions that can permanently affect your vision or lead to more serious vision problems.

In each of these cases, you will be responsible for a 20 percent coinsurance or copayment plus any deductible.

All Medicare Advantage plans must cover everything Medicare Part A and Part B covers as a bare minimum. But most Medicare Advantage plans also offer vision coverage.

However, since vision is considered additional coverage, you will have to pay extra for it.

Medicare Advantage plans may cover all or part of the costs of routine eye exams, glasses, contacts and any fittings for frames and lenses.

But you should shop around and look closely at exactly what a plan offers if you’re interested in vision coverage. Not all plans include vision care.

Remember that Medicare Advantage plans are offered by private insurance companies and coverage differs from plan to plan and depending on the state where you live.

Seniors can still find private vision insurance if they shop around. Private vision policies can cost as little as $11 to $20 a month depending on the level of coverage you want.

In deciding how much to spend on vision insurance, you should consider how much eye exams and glasses cost you on a yearly basis and compare that to the amount you’ll spend on premiums and copays over the course of a year.

Before buying a private insurance plan, you should read over any policy and ask questions about what you want and expect to be covered by a plan.

You may also want to compare the costs of a private plan to the cost of adding vision coverage to a Medicare Advantage plan when shopping for the best coverage for your needs.