A Guide to Medicare Vision Coverage7 minute read

7 minute read

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Updated for September, 2019

Everyone 60 years of age and older should have an eye exam every single year, according to the American Optometric Association (AOA). This is extremely important for this particular segment of the population because the AOA says many conditions affecting older adults tend to have no early warning signs whatsoever.

senior man getting checked for glacoma at the eye doctor

Regular eye exams can help identify any changes in vision while potentially treatable, according to the AOA. A few of the issues most problematic to the elderly include:

Age-related macular degeneration

An eye disease that causes vision loss in the center of the eye (not the sides), making it harder to engage in forward-looking activities that require a bit of focus, such as reading, driving a vehicle, or watching your favorite television show.

Cataracts

Characterized by cloudy eye lenses causing blurry vision, cataracts can dull colors and increase glare sensitivity.

Dry eye

Afflicting a large number of the elderly, dry eyes occur when tears are too few or are poorer in quality, ultimately reducing vision clarity.

Glaucoma

This term covers a variety of eye diseases that damage the optic nerve and cause a loss in vision, eventually reducing peripheral (side) vision too if left untreated.

Retinal detachment

Detachment occurs when the retina is torn from the underlying tissue due to trauma, inflammatory eye conditions, or other health issues. This causes permanent vision loss if it’s not treated quickly.

What benefits does Medicare offer toward these types of issues to help participants get and keep the best vision possible as they continue to age?

With a Medicare Advantage plan, you are entitled to all of the benefits covered under Original Medicare (the federal health insurance program), but they are provided by private insurance companies instead.

In addition to covering some of the expenses associated with treating age-related macular degeneration, Medicare covers a specific set of costs related to cataract surgery conducted via traditional surgery or lasers because this is deemed a “medically necessary” procedure.

Medicare Part B also assists by helping pay for corrective lenses required after cataract surgery in which an intraocular lens is implanted. These corrective lenses—whether eyeglasses or contacts—must be purchased from a Medicare-enrolled supplier in order to be covered either in whole or in part.

To determine what your portion of the expenses would be if you have Medicare Part B and need cataract surgery, Medicare.gov recommends checking with the doctor or medical care facility conducting the procedure. They’ll be able to give you a better estimate based on:

  • How much care you’ll need post-surgery
  • Whether the surgery will be conducted on an inpatient or outpatient basis
  • Whether you’ve met your deductible
  • If you have any copayments
  • If you have any other additional insurance policy that may pick up some or all of the costs

eye doctor talking to senior man

If you want a Medicare-based plan that offers vision coverage, Medicare Advantage is one option to consider.

With a Medicare Advantage plan, you are entitled to all of the benefits covered under Original Medicare (the federal health insurance program), but they are provided by private insurance companies instead.

This allows you to choose a policy that offers vision coverage in addition to the typical Medicare coverages. You may pay a bit more for it, but it may be cheaper than paying your own expenses toward exams, eyeglasses, and contacts on an annual basis.

Do not confuse Medicare Advantage with Medigap insurance. Medigap doesn’t typically offer vision care or eyeglass benefits, but it can be used to help cover costs associated with copayments, coinsurance, and deductibles.

Medicare vision coverage is limited, but it does provide benefits in some cases. It’s important to always check with your individual plan to know for sure what your policy will pay and what amount you’ll be responsible for.