Keeping eyes healthy and catching vision problems early helps seniors stay as independent as possible. HealthMarkets explains what types of eye care are covered by Medicare and additional options for vision care.
According to the World Health Organization, 80% of blindness is preventable.
But for seniors with Medicare, it may be confusing to figure out if vision care is covered by their plan.
We share an overview of what types of eye care Medicare does and doesn’t cover, additional options for vision care, and why eye health is an indicator of overall health.
Medicare vision coverage: what’s included
Medicare Part B generally covers doctors’ services, medical supplies, and outpatient care.
For eye care and vision, Medicare Part B covers:
- Eye exams for diabetes patients – Annual exams for diabetic retinopathy
- Glaucoma tests — Annual exams for people at high risk. High-risk individuals either have diabetes, a family history of glaucoma, are African American and age 50+, or are Hispanic and age 65+
- Macular degeneration tests and treatment – Tests and treatments for people with age-related macular degeneration (AMD), including certain injected drugs
- Corrective lenses following cataract surgery – Helps pay for corrective lenses (either one pair of standard eyeglasses or one set of contact lenses), if cataract surgery is used to implant an intraocular lens
For all of the above treatments, patients generally pay 20% of the Medicare-approved amount for doctors’ services, drugs, and corrective lenses, in addition to the Part B deductible.
For treatments that take place in a hospital outpatient setting, there will also be a copay.
Additional options for vision care coverage
Medicare Advantage Plans (Part C) include the same coverage as Original Medicare (Parts A and B).
Each Medicare Advantage plan varies, but they generally offer extra benefits that Original Medicare doesn’t cover, like vision exams and eyeglasses.
If seniors have Medicare Part B and relatively healthy eyes, another option for coverage is supplemental vision insurance.
Supplemental plans can help pay for eye exams, prescription glasses, contact lenses, and vision correction procedures – benefits that aren’t covered by Original Medicare.
Eye health is an indicator of overall health
Medicare doesn’t cover routine eye exams for non-diabetic patients – like those used to prescribe glasses or contact lenses.
But even if your older adult isn’t diabetic, that doesn’t mean they should skip annual eye exams.
Regular eye exams help with early detection of issues such as cataracts, damaged blood vessels (which can lead to blindness), glaucoma, macular degeneration, and diabetic retinopathy.
According to the CDC, “of the estimated 61 million U.S. adults at high risk for vision loss, only half” have had an eye exam in the past year.
There’s even research suggesting that eye exams can detect signs of retinal abnormalities that might link to overall cognitive decline.
The bottom line? Eyes can say a lot about overall health.
Vision insurance can save money
If your older adult has Medicare Part B and doesn’t have a disease like diabetes, glaucoma, or macular degeneration, preventive eye exams, treatments, and corrective lenses might come at a significant out-of-pocket cost.
If that’s the case, a supplemental vision insurance policy may be worth considering. It could help cover the costs of eye care to keep eyes healthy and catch any vision problems early.
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Guest contributor: Michael Z. Stahl serves as Executive Vice President of HealthMarkets – one of the nation’s largest independent insurance agencies in the Medicare, individual, and supplemental health, life, and small group insurance markets. He has a B.S. in Economics from The Wharton School, University of Pennsylvania, and holds the chartered property casualty underwriter (CPCU), associate in insurance accounting and finance (AIAF), and associate in reinsurance (ARe). An avid Kansas City Royals fan, he lives in Dallas with his wife and children.
Image: Eyewear Experts
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