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Senior Vision Health–What You May Need and What Medicare Covers

Regular eye exams can help maintain your vision and catch problems before they become more serious. However, Original Medicare, Part A and Part B, does not usually cover routine vision services. You may be able to find a Medicare Advantage plan that offers vision coverage, however. Medicare Advantage plans, also called Medicare Part C, are sold by private insurance companies with Medicare’s approval. They are required to offer at least the same amount of coverage as Original Medicare, but can include other benefits, like routine vision, dental, and hearing coverage.

If you prefer to remain covered by Original Medicare, then you may wish to join a stand-alone vision plan to ensure all of your vision needs are covered.

Eye exams for seniors

Your vision can change as you age, and it’s a good idea to monitor anything unusual and inform your doctor. Older adults may want eye exams to detect conditions such as:

  • Glaucoma
  • Cataracts
  • Diabetic retinopathy

These conditions are often treatable, particularly if discovered early. Screenings for these diseases may be covered by Medicare.

For example, if your doctor determines that you are at high risk for glaucoma because you have diabetes, a family history of glaucoma, are African American and 50 or older, or are Hispanic American and 65 or older, then Medicare will cover this screening. You will have to pay 20% of the Medicare-approved amount, and the Part B deductible will apply. If the screening is done in a hospital outpatient setting, you will pay a copayment.

Routine eye exams are not covered by Original Medicare, however, and you would need to either pay out of pocket or have additional coverage, such as with a Medicare Advantage plan.

Ophthalmologists, optometrists, and opticians

You may require different types of eye care, and that may be administered by various types of vision specialists. Ophthalmologists have an M.D., and they specialize in eye and vision care. Optometrists conduct vision tests and some related screenings, but they are not medical doctors. Opticians are specialists who fit your prescriptions to eye glasses or contact lenses. They do not treat eye diseases.

Depending on your needs, you may see one or all three of these health-care providers. Always confirm whether or not your provider accepts Medicare assignment first so you are better aware of what your costs may be.

Vision coverage under Medicare

While most routine and preventive care is not covered under Original Medicare, cataract surgery is covered when it is medically necessary. Medicare also covers a pre-surgery exam, as well as surgery anesthetic. Medicare only pays for expenses directly related to the treatment of cataracts; any other procedures performed at the same time of surgery will be billed separately.

Other items that may be necessary due to eye surgery, such as intraocular lenses and eye prostheses, are usually covered by Medicare as well. If a beneficiary gets the surgery, but not the intraocular lens implants, then Medicare could potentially cover bifocals from an approved supplier.

This article is for informational purposes only. It should never be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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