Are annual eye exams covered by Medicare?
Does Medicare cover annual eye exams? Eye health is of vital importance, especially for seniors. For prescription glasses and contacts, Original Medicare does not cover annual exams. It will, however, pay for exams involving your eye health. This includes exams for degenerative eye disorders like glaucoma, cataracts, and macular degeneration. However, you can purchase vision insurance through a Medicare Advantage plan if you want Medicare vision coverage.
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UPDATED: Dec 6, 2021
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- Original Medicare does not cover annual exams for vision problems that require prescription glasses or contacts
- Original Medicare does cover eye health conditions like macular degeneration, cataracts, eye injuries, and glaucoma
- If you need vision coverage, there are Medicare Advantage plans that offer it
Eye exams are an essential part of your health, especially for seniors who are more likely to experience eye problems. Your annual eye exam checks a lot more than the strength of your vision. It checks for developing problems like glaucoma, cataracts, and other degenerative issues.
Since eye exams keep track of your eye health, you should schedule one once a year, even if you don’t need glasses or contacts. The importance of your eye health leads many to ask, “Does Medicare cover vision?”
The answer is a little complicated. Medicare provides health insurance to seniors and other qualifying Americans – it isn’t vision insurance. However, you can get vision coverage through Medicare Part C.
So, does Medicare cover annual eye exams? While Original Medicare does not, Medicare Advantage can cover your vision needs. If you’re interested in seeing what quotes might look like for you, enter your ZIP code into our free tool to get started.
Does Medicare cover eye exams?
Original Medicare does not cover eye exams. Medicare is health insurance for people over the age of 65 or who have qualifying disabilities. Original Medicare covers doctor appointments, preventative healthcare, surgery, and other healthcare services.
However, you can get eye coverage through Medicare Advantage. Medicare Advantage offers the same coverage as Original Medicare, but you purchase it through private companies. Usually, Medicare Advantage includes both Parts A and B and prescription medication coverage through Part D.
With Medicare Advantage, you can purchase additional coverage that Original Medicare does not offer. This can include dental, hearing, and vision plans.
Additionally, you can also add coverage for things like services that promote your well-being, transportation to and from your doctor, and over-the-counter medicine.
Medicare Advantage has to offer what Parts A and B cover at a minimum. You may also find a plan that includes:
- Annual eye exams
- Prescription medication, such as eye drops
- Prescription glasses or contacts
If you need Medicare vision coverage, be sure to check the Medicare Advantage plan you’re thinking about signing up for. Not all plans include vision, and some areas don’t offer vision at all.
What does Medicare pay for vision care?
Unlike annual eye exams for glasses, Original Medicare will pay for vision healthcare services in some situations. If you need their services, Medicare does cover ophthalmologists.
A doctor must order the exam because they see signs of or suspect you have an eye health condition to be eligible. You can get Original Medicare eye exams for conditions like:
- Diabetic retinopathy. You have to have diabetes, and your doctor must recommend it. Medicare will only cover one exam per year for this condition.
- Glaucoma. Medicare might cover an annual glaucoma exam if you have diabetes, have a family history of glaucoma, or meet the age requirements.
- Macular degeneration. If you have macular degeneration or your doctor thinks you might, Medicare does pay for eye exams, injections, and other related care.
- Cataracts. Medicare will cover eye exams and surgery for cataracts. Additionally, you might be able to get Medicare glasses if you’ve had surgery to implant an intraocular lens.
- Injuries. If you injure your eye, Medicare typically covers the cost of the exam to evaluate the damage done.
As you can see, Original Medicare will cover many eye services when they are medically necessary, and they are related to your health. If you’ve been asking, “Does Medicare cover eye surgery?” the answer is probably yes.
If you need to find eye doctors that take Medicare, you can start by calling the office of your choice and asking. If you don’t have anyone in mind, you can check your state’s website for a list of participating healthcare providers.
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How much does Medicare cost?
The cost of Medicare depends on what you need.
Original Medicare is the cheapest option. Medicare Part A, which covers hospital services, typically has no monthly payment if you paid taxes to Medicare for a specific period. Most people get free Medicare Part A.
Medicare Part B covers outpatient services – this is what usually covers Medicare-approved vision services. Part B has a deductible of $203 per benefit period (which will rise to $217 in 2022). Additionally, monthly payments must be met (for most people, the rate is $148.50 a month).
Once your deductible is met, Medicare Part B covers 80% of approved health services. You’ll have very affordable prices for most treatments and services.
The price of Medicare Advantage is difficult to estimate before you sign up for a plan. You’ll at least have the same monthly payment as Medicare Part B (or $148.50 a month). However, the price of Medicare Advantage can vary depending on the coverage.
Find Medicare Vision Plans
If you wear glasses or use contacts, it can be highly beneficial to sign up for a vision plan under Medicare Advantage. Vision care can be expensive – you don’t want to have to pay for everything out-of-pocket.
If you’ve been wondering, “Does Medicare cover annual eye exams?” you can find an affordable Medicare Advantage plan that will meet your needs by shopping around for rates. If you’re ready to see what quotes might look like for you, enter your ZIP code into our free tool today.