Maintaining healthy vision is crucial at every stage of life, including as you age.
But when you turn 65 and enroll in Medicare, routine eye exams may not be automatically covered. Whether or not these exams are included in your coverage depends on the Medicare plan you select.
Let’s take a look at how eye exams are covered by Original Medicare and Medicare Advantage.
If you are covered by Original Medicare (Parts A & B)
Routine Eye Exams
Unfortunately, routine eye exams and corrective lenses (such as contacts and eyeglasses) are not covered by Original Medicare. You are responsible for 100% of the cost of routine eye exams required for eyeglasses, bifocals, and/or contact lenses.
However, there is one exception to this limitation: Original Medicare will cover one pair of corrective lenses following cataract surgery. Any subsequent replacements due to breakage or prescription changes will be your responsibility to cover.
Covered Eye Tests
Certain eye tests are covered under Original Medicare. After meeting the Part B deductible, you will be responsible for paying 20% of the approved amount for your doctor’s services. These can include:
- Annual eye exams for diabetic retinopathy
- Yearly glaucoma tests for high-risk individuals, such as:
- Diabetics
- Individuals with a family history of glaucoma
- African Americans aged over 50
- Hispanics aged over 65
If you are covered by a Medicare Advantage Plan (Part C)
Unlike Medicare Parts A & B, Medicare Advantage plans may offer more comprehensive vision care benefits, either fully or partially, depending on the specific plan you’ve selected.
Routine Eye Exams
Some Medicare Advantage plans do cover — at least partially — routine vision care and expenses related to eye exams, prescription contacts, and prescription eyeglasses and sunglasses.
The coverage options and costs can vary from plan to plan and may not be available in all areas, for example:
- Some plans may require an extra fee if you opt for vision care as an add-on, while others include this coverage without any additional premium cost.
- Certain plans may cover a percentage of the eye exam or eyewear costs, with you responsible for the co-pay. Alternatively, some plans may have an out-of-pocket maximum that must be met before covering any eye care expenses.
The extent of coverage varies across plans, so it’s essential to consult your plan provider and review the specifics of your Medicare Advantage coverage.
Understanding what’s covered and the associated costs will help you make informed decisions regarding your eye care needs.
Let’s see how we can help!
Need help navigating your coverage and your options? Contact a Medicare expert at Guided Solutions to review your needs and get help in finding the best solutions in your area.
