It’s important to maintain healthy vision. At any age.
But when you turn 65 and enroll in Medicare, routine eye exams may not be automatically covered. The Medicare plan you choose determines whether or not these exams are included in your coverage.
IF YOU ARE COVERED BY ORIGINAL MEDICARE (PARTS A & B)
You pay 100 percent for the routine eye exams you need to get eyeglasses, bifocals, and/or contact lenses.
However, eye tests for certain conditions can be covered under original Medicare, including:
- Annual eye exams for diabetic retinopathy
- Yearly glaucoma tests for high-risk individuals, including:
- diabetics
- those with a family history of glaucoma
- African Americans >50 years old
- Hispanics >65 years old.
How much you will pay
After you meet the Part B deductible, you pay 20 percent of the amount approved for your doctor’s services.
IF YOU ARE COVERED BY A MEDICARE ADVANTAGE PLAN (PART C)
You may receive full or partial vision care benefits with your health insurance coverage. Again, it depends on the plan you choose. All plans vary, so check with your health plan provider to understand what eye care benefits you can receive.
How much you will pay
In general, a Medicare Advantage plan may cover at least a portion of the costs associated with eye exams, eyeglasses, and contacts.
Some plans charge extra if you add vision care as an option; others provide this coverage at no additional premium cost.
Beyond that, when you go to your eye doctor or optician, some plans cover a portion of the cost of your eye exam and/or eyeglasses or contacts and may charge you a co-pay, while others may have an out-of-pocket maximum you need to satisfy before they provide any benefits for eye exams and other services.
It’s a good idea to review the details of your Medicare Advantage coverage before making an eye test appointment or receiving services from an eye care professional so you know exactly what’s covered and how much it will cost.
Need help understanding your coverage and your options? Contact a member of our Guided Medicare team today.
