Does Medicare Pay for Eye Exams?

Eye exams are necessary for diagnosing possible problems with vision. The risk of developing certain eye conditions such as cataracts increases with age, making it necessary to get eye exams. With this in mind, it’s important for any Medicare beneficiary to understand the coverage they can receive for vision services with their Medicare plan.

How Medicare Covers Eye Exams

In general terms, Original Medicare does not provide coverage for routine eye exams. However, under some circumstances, you may get coverage for certain eye exams if it’s absolutely necessary to better your overall health. For example, Medicare enrollees with diabetes may need certain eye exams as they are at a higher risk of developing a condition known as diabetic retinopathy. This occurs when the blood vessels tasked with supplying blood to the retina become damaged due to high blood sugar levels. This could result in vision loss. 

To help prevent this, Medicare covers eye exams for enrollees diagnosed with diabetes to detect diabetic retinopathy. This test is covered under Original Medicare once a year. Apart from diabetic retinopathy tests, Original Medicare also covers glaucoma tests. Glaucoma is a health condition that damages the optic nerve, which can result in loss of vision. The risk of developing this condition increases with age. 

Under Original Medicare, you can get coverage for glaucoma tests once every 12 months if you are at high risk for developing the condition. High-risk factors include family history, diabetes, ethnicity, etc. Medicare also covers eye exams and treatments for beneficiaries that have macular degeneration that is related to aging. Medicare also covers certain aspects of cataract surgery. 

Which Parts of Medicare Will Provide Coverage?

If you have an eye condition and you are admitted to the hospital, Medicare Part A will cover the costs of eye exams and treatments if they are approved. You will be required to pay a certain amount as coinsurance. Medicare Part B covers outpatient eye care services such as diabetic retinopathy tests, glaucoma testing, macular degeneration testing, etc. 

Medicare Advantage plans often offer routine vision coverage as an extra benefit, but the costs and coverage will vary by plan. If you’ll need regular eye exams, it is advisable to consider enrolling in Medicare Advantage or a standalone vision insurance plan.

Are you interested in learning more about vision coverage through Medicare? Kannonball Insurance Solutions can help! We specialize in Medicare and will make sure you find a plan that meets your coverage needs.