Medicare Vision Coverage
By Nancy DellaVecchia
Many seniors are unaware that Medicare and Medicare supplement plans, otherwise known as Medigap, do not cover routine eye examinations. Unlike health plans offered by employers that cover the cost of one eye exam and one pair of glasses or contact lenses per year, Medicare benefits only cover eye care if it relates to a medical condition like cataracts, glaucoma, diabetic retinitis or macular degeneration.
Medicare Advantage vs. Medigap
Medicare Advantage replaces Medicare with a private insurance plan, the cost of which is subsidized by Medicare. Some Medicare Advantage plans may offer yearly eye exams and coverage for glasses or contact lenses while others may not.
Medicare Advantage plans can do this because they are preferred-provider plans that can offer a range of services as long as they provide the basic coverage level offered by Original Medicare. They often charge co-payments and deductibles if medical care is needed, so you should be sure to read the fine print if you go with a Medicare Advantage plan. The costs and the coverage vary by insurance company and the state in which you live.
Medigap or Medicare supplemental insurance consists of 10 standardized plans, none of which cover the cost of routine eye exams. Medigap plans also do not cover the cost of eyeglasses or contact lenses.
You may encounter literature in which a Medicare Advantage plan offering vision coverage is being marketed as a Medicare supplement or Medigap plan. Make sure to ask your agent to clarify whether the plan is a Medicare Advantage plan or Medigap plan.
Medigap plans are designed to cover deductibles, co-payments and excess charges that Original Medicare does not cover, which can save thousands of dollars if significant Medicare care is needed. Coverage for things like vision and dental care are not included, however.
When Is an Eye Exam Covered?
Eye exams are covered by Medicare if you have experienced a loss of vision or chronic eye irritation. If a doctor finds a medical problem like blepharitis or dry eye syndrome during a routine exam, the exam is not covered, but subsequent medical treatment is covered. If you go into an exam with a medical complaint and the doctor fails to find a medical problem, the eye exam may not be covered by Medicare.
Glaucoma is an eye disease with few symptoms. It can gradually cause patients to lose vision, but many people are not aware that they have the disease, which can result in blindness.
Medicare has approved glaucoma screenings for certain high-risk individuals. Yearly glaucoma screenings are covered for individuals with a family history of the disease, African Americans over age 50, Hispanics over age 65 and individuals with diabetes.
If you need glasses, talk to your eye doctor and optician about discounts. Some providers offer discounts to seniors or members of AARP or AAA, and some of these discounts can total as much as 15 percent. Indigent seniors can check with their local Lyons Club, which offers assistance to people who are unable to afford eye exams and glasses.
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