Coverage for Eye Exams & Other Eye-related Medical Items Can Differ
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According to the Vision Council of America, almost 75% of adults use some type of vision correction. Regardless of whether they are glasses, contact lenses or reading glasses, that number is quite high. Given that number, you will soon be aware that Medicare Advantage plans, Original Medicare do not cover routine eye checks. But it does cover medically necessary treatments as directed by a doctor. This can improve or cure chronic eye conditions, such as glaucoma or cataracts. It is best to get professional advice first. This way you will know if your condition qualifies. Lasik vision correction surgery is not considered medically necessary. Anything that directly affects health or wellbeing may be considered.
Medicare is the government program that provides health care services. For individuals with disabilities, you will find eligibility. The program offers a broad set of benefits to retirees, but does not provide coverage for all health and medical services. For example, Medicare does not typically cover the cost of eye exams. But some eye conditions and some vision services are reimbursable under the program. Glaucoma screening is available every twelve months for patients who are deemed as high risk for the disease. High-risk patients include people with diabetes and those with a family history of glaucoma.
All other Medicare patients must pay for their own eye exams, including the cost of screening for glaucoma. Medicare also reimburses the cost of screening in some patients including age-related macular degeneration. If your ophthalmologist has diagnosed you with this condition, check with the billing office about your coverage. You may get a possible Medicare reimbursement.
Medicare does not usually pay for the cost of glasses and contact lenses. If you have Medicare, discuss prescription glasses costs with your vision provider. Many vision service providers will help you to get the best possible prices, and so if you have a Medicare supplement or a Medicare Advantage plan, that plan may carry some of the costs associated. These may include prescription glasses or sunglasses and contact lenses also.
If you have had cataract surgery that includes the implantation of an intraocular lens, Medicare will pay for the glasses. And contact lenses prescribed by your ophthalmologist following that surgery. One single pair of glasses is covered by Medicare and no more than one. This must be confirmed by a doctor that can verify your condition.
If you choose a Medicare Advantage plan over traditional Medicare, you can find different benefits. These may include:
Private Medicare insurance companies offer Medicare Advantage plans. However their plans and prices may vary and you will find some services and restrictions included. You can find information about Medicare Advantage programs in your area by contacting insurance companies directly, or by visiting the Medicare.gov website for more information.
Parts A and B of Original Medicare usually won’t cover you for eye tests or new glasses or contacts. However, it is known that Medicare Part B will cover an annual eye exam. This means that every 12 months you can get a test if you have a disease such as diabetes or are at high risk for glaucoma due to ill health (as previously mentioned).
Glaucoma treatment is usually covered by Medicare. Outpatient laser surgery is included in Part B. You will find that any associated medications/treatments will be included within Medicare Part D. Out-of-pocket costs associated with deliveries will depend on the Part D plan form. If you are new to enrollment in Part D, please take some time to understand how to avoid the Part D penalty.
If you have Part A and Part B, you will probably pay 100% of the costs of all treatment and glasses/contacts needed also. If you have a known medical problem with your vision, such as blepharitis or dry eyes, Medicare may pay to help aid the problem. This includes your doctor visits for treatment.
If you have an issue such as cataracts, you can also get assistance. Medicare pays for cataract surgery. However, you will need a professional to say it is necessary, and this can come from your doctor. The cost of cataract surgery may vary depending on different circumstances. Medicare will cover 80% of the surgical costs generally speaking.
You can use other insurance to help fill in the gap such as Medigap which will assist you in paying the remaining 20%. These are private health insurance plans found across the USA. As you can see, there are quite a few options when it comes to eye health under Medicare. So, please feel free to reach out to us directly at (888) 352-6672 and we will help you feel comfortable with the choices you are making with your plan to cover eye-related issues that are specific to you.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.