Eye exams are essential for people who have problems with their vision. As people age, they may be more at risk for glaucoma and cataracts. When you begin your Medicare coverage in your senior years, you might be wondering if Medicare will cover your eye exams? We’ll discuss in this article Medicare’s coverage of eye exams and vision coverage in general.
Medicare and Eye Exams
Unfortunately, Original Medicare Parts A and B do not cover eye exams. Many beneficiaries are surprised when they realize Medicare does not cover vision services. However, there are other eye exams that Medicare may cover. Those exams include eye exams for people with diabetes, glaucoma tests, cataract surgery, and macular degeneration tests and treatment. If you have diabetes, you could develop diabetic retinopathy. This is when blood sugar levels damage your retina’s blood vessels.
As you can see, if a procedure is medically necessary, Medicare will likely cover it. Routine services, such as an eye exam to get new glasses, are not covered.
Coverage for Vision Services
Fortunately, you can pick up a private insurance plan if you need your routine eye exams to be covered. There are dozens available for you to choose from. Some plans will bundle hearing and/or dental services since Medicare doesn’t cover those types of services either. You can research your choices for a vision, dental, hearing plan online to ensure you are covered.
Medicare Advantage Plan Coverage
If you have a Medicare Advantage plan, you may be wondering if it will cover eye exams. Medicare Advantage plans provide an option for you to receive limited vision coverage. You may see some Advantage plans with vision, hearing, and dental. However, Medicare Advantage plans do not have to include these additional benefits in all their plans.
If you were to enroll in a plan with additional vision benefits, the plan will determine how much it will cover these benefits. Some plans offer a small co-pay for your eye exam; some offer an eye exam but no glasses or contacts coverage. Shopping around helps you guarantee that you will get the best plan for you with the coverage you need.
Something important to keep in mind is that Medicare Advantage plans change their benefits each year. Your eye exam coverage may be a benefit this year but may not be on your plan next year. You will be notified of any changes in your plan around September, so check your plan around that time to ensure you still receive the coverage you need.
Shopping around helps you determine which plans are the best prices, coverage-wise and long-term. You could call multiple providers to determine the pricing and benefits of plans. You could also contact the provider and ask for a discount on a plan for paying cash. Some providers provide cash discounts for paying in cash upfront vs. billing the insurance carrier.
Paying for Vision Care with an HSA
Suppose you contributed to a health savings account (HSA). In that case, you could use the funds within that to pay for vision expenses. These are qualified medical expenses that can be covered legally by an HSA. Keep this in mind when paying for the plan you select.
Finding Additional Help for Vision Coverage
You can always find additional help when trying to find good vision coverage. You can check out Medicare groups on Facebook to see what Medicare beneficiaries recommend. Medicare brokerages like Boomer Benefits offer phone assistance when selecting a plan so you can ask questions and talk with an agent live through the enrollment. Medicare.gov also has resources on vision coverage. Using the internet to find additional help has been extremely helpful to many Medicare beneficiaries!
Unfortunately, Original Medicare does not cover routine eye exams. However, Medicare will cover medically necessary eye procedures such as eye exams for people with diabetes, glaucoma tests, cataract surgery, and macular degeneration tests/treatment. You can pick up additional coverage through a private insurance broker or a Medicare Advantage plan. Shopping around will help guarantee that you will get the best plan for yourself. If you contributed to an HSA, you could use that money to pay for vision expenses. In addition, you can find additional help on the internet for selecting vision coverage.