Medicare Vision Screenings
Original Medicare, Part A and Part B, doesn’t cover much in the way of vision or eye care. Eyeglasses and contacts are not generally covered, unless they are deemed medically necessary when following cataract surgery. Eye exams may be covered if there is a medical reason, such as life-threatening illness or the by-product of a health issue that Medicare does cover. Those who choose to enroll in Medicare Advantage (Medicare Part C) may be able to find a plan that includes routine vision as a part of its benefits package. Medicare Advantage plans are available from private, Medicare-approved insurance companies; these plans must include at least the same benefits as Original Medicare, Part A and Part B (except for hospice care), but may offer other health benefits as well, such as routine vision services.
Because Medicare Part B covers some preventive care screenings, certain tests related to vision are covered. By extension, Medicare Advantage also covers these preventive screenings because these plans must provide the same amount of coverage as Original Medicare, Part A and Part B.
Medicare Part B covers the “Welcome to Medicare” exam, which is a thorough examination of your current health and medical history. This exam is available within the first 12 months of your Medicare enrollment. Your doctor will evaluate your medical history, existing conditions, and drug prescriptions to determine the best way to keep you healthy. During this exam, your vision is checked as it is not uncommon for it to weaken with age. There are also other, more serious conditions that could be taking shape as well. The Welcome to Medicare exam functions as a way for your health-care provider to catch them.
Some of the other vision screenings that play a crucial role in keeping you healthy throughout your Medicare years include:
Glaucoma screening: Available once every 12 months for Medicare beneficiaries with diabetes or a family history of glaucoma, an eye disease that can cause blindness. African-Americans over age 50 and Hispanics age 65 and older are also eligible for annual screenings. These checks consist of a dilated eye examination, a test to determine how sharp your vision is, and a test of the pressure inside your eye, called an intraocular pressure measurement. After these tests, the medical provider must clearly document that these tests were performed.
Diabetic retinopathy screening: Medicare covers one annual vision exam to check for diabetic retinopathy for all beneficiaries who have diabetes and are enrolled in Medicare Part B. To be covered, you must get the screening from an eye doctor who is legally authorized to perform the screening in your state. You’ll be responsible for 20% of the Medicare-approved cost for the screening, after reaching the Medicare Part B deductible. You may also need to pay a copayment if you get the screening as a hospital outpatient.
Macular degeneration screening: Covers certain diagnostic tests and treatments of this fairly common condition. Macular degeneration can cause severe vision loss. For treatments concerning macular degeneration, the beneficiary pays 20% of the Medicare-approved amount with Medicare Part B after any applicable deductible. Those with Medicare Advantage plan coverage may pay a different percentage, because private insurance companies set their own amounts.
You can type your zip code into the form on this page to see a list of Medicare plans in your vicinity. To speak with one of eHealth’s licensed insurance agents, just call eHealth at the phone number below this article.