For all that Medicare does offer concerning healthcare, it doesn’t provide any coverage for vision services such as routine eye exams, contact lenses, or eyeglasses. However, in certain circumstances that Medicare calls “medically necessary,” they will cover certain types of eye care.
Eyecare is very important for all people. The Center for Disease Control and Prevention (CDC) says that vision impairments, and even blindness, are increasing among all people, regardless of race or ethnic background. The CDC believes that, “the number of blind and visually impaired people in the United States is estimated to double by 2030 and triple by 2050” due to the aging population.
Does Medicare Cover Eye Exams?
Generally speaking, Medicare Part A and Part B do not cover routine eye exams, nor do they cover contact lenses or eyeglasses. However, Medicare Part B does have a benefit that will allow a beneficiary to get an annual eye exam every 12 months. However, this is for people with diabetes who are at a higher risk of contracting glaucoma if they do not stay current on their eye exams.
How Do I Get Any Form of Eye Care from Medicare?
If you are looking to enroll in a Medicare plan that includes routine eye exams and more, your best option is to look at Medicare Advantage plans. Medicare Advantage is also referred to as Medicare Part C coverage. This is just another benefit of having Medicare Part C; it comes with extra benefits that Part A and Part B might not have. Note, even though the routine eye exams are coming from your Part C coverage, if you enrolled in it, beneficiaries still must pay their Part B premium to keep their Part C coverage. Also, keep in mind, not all Part C plans with routine eye care may be offered in your area.
Will Medicare Cover Eyeglasses?
Medicare does not offer a standard vision plan that covers eyeglasses for beneficiaries. However, if a Medicare beneficiary with Medicare Part A and Part B has had cataract surgery, Part B can help. Although the person would have had to have intraocular lens implants, then Part B could help offset the corrective or contact lenses costs.
Will Medicaid Cover Eye Care Then?
Medicaid has stringent rules on what your total household income can be for you to qualify to receive Medicaid benefits. But, if you meet their criteria, you and your family can receive eye care, including routine eye exams and more. Medicaid covers comprehensive eye exams and basic eye exams, which could include procedures such as pupil dilation, glaucoma checks, color blindness checks, and many more preventative exams.
If you qualify, Medicaid also covers eyeglasses which include lenses, fittings, and frames. Repairs and replacements of glasses are offered as well.
What are Medically Necessary Eye Care Services?
If you have been reading through your Medicare policy coverage Part A, Part B, Part C, Part D, and other coverages, you might have come across the term “medically necessary.” This term could be significant for a beneficiary if they were previously told that Medicare would not cover a surgery they needed. However, if, after further review, Medicare assesses your situation and determines that you need the surgery for your well-being, more often than not, they will help cover some of the costs for the procedure.
If a beneficiary already has glaucoma or degenerative eye disease, or cataracts, Medicare does not want these conditions to worsen. If Medicare determines that some of your eye procedures or surgeries are medically necessary, your Medicare Part B would be the one to help offset some of these procedures and surgeries.
Most people 65 years or older are eligible for premium-free Medicare Part A coverage. However, Part B is not free and has a premium associated with it. If you’re looking to add a Part B policy to your Medicare Part A coverage, the monthly premium is based on the beneficiary’s income; the more you make, the more you pay.
In addition to paying a monthly premium for Part B coverage, remember that Part B also comes with a yearly deductible of $233 (in 2022). There could also be a copay for outpatient services. When a bill comes in that falls into the Part B bucket, the beneficiary is responsible for 20%, and Part B picks up the remaining 80%.
Note: Even with the medically necessary criteria above, routine services such as eye exams are still not covered.
For more information about Medicare and what it does and does not cover, contact us! Our licensed insurance experts will be happy to answer any questions you have.