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Does Medicare Cover Vision Care?

by Northern Life

You have just discovered your cataracts and are considering the options for treatment. Medicare is a government-sponsored health insurance programme that covers the cost of many medical treatments, but will it cover the costs of your new vision care? No one can answer that with any certainty, but here is information about what medicare will cover and what you should keep in mind when choosing an eye doctor. Whether you are a recent retiree or you have years of contributions to your medicare account, it’s nice to know that several eye conditions and services are covered. Given that 40 million Americans have difficulty seeing clearly, this is good news for all. If you’re not sure what your eye health plan covers, here is a list of conditions and services that medicare considers “vision care.”


Vision Care


Vision care covers procedures that improve overall vision, such as surgery, laser eye surgery, cataract removal, and certain contact lenses. Unfortunately, the type of procedure you have and the length of time you’ll be treated influence what medicare will cover. If you have diabetes or glaucoma, it’s hard to get Medicare coverage for eye care. If you have a chronic eye condition that doesn’t affect your sight, you have coverage under medicare. For example, some older adults with vision problems benefit from the 20/40-20/70 rule. In this case, for each 20/20 vision correction item, medicare covers one prescription eye exam and one surgery.


Vision Correction


Vision correction is any treatment that improves your eyesight. This is often the range of vision from 20/200 to 20/50. The common types of correction are cataract surgery, laser eye surgery and eyeglasses. Cataract surgery removes the cloudy lens in your eye that causes blurry vision. If you’re over 60, medicare will cover $1,000 of your cost for this procedure. You also may be able to get a Medicare prescription for new glasses as part of your vision care. You’ll be eligible for two separate eye care items: treating your retina and providing a new pair of glasses. The one item that’s not covered is the cost of a contact lens.


Bottled Eyedrops


Medicare will cover most eye drops, which are stored in bottles that you keep on hand at home. The only exception is if you take custom-made eye drops. Because these are not in a bottle, they are considered part of your overall treatment plan. So if you don’t need eye drops that day, you can skip them. If your doctor recommends a different type of eyedrop, they will still receive coverage. You’ll be responsible for the cost of replacing the drops from your prescription.


Prescription Eyeglasses


Medicare will cover prescription eyeglasses for older adults with an eye disease or condition and cannot see well enough with their natural vision (20/200). Medicare will also cover prescription glasses with a pair of minor correction lenses (20/40). These are the types of glasses that most people wear every day. What’s left out is the expense of getting custom-made eyeglasses. You’ll have to pay the cost for this particular item and have new prescriptions, but you won’t be responsible for any replacement costs. Overall, if you qualify for vision care, medicare will cover the eye care expenses of blind individuals.


Medicare Part A


Medicare Part A is the hospital insurance programme. It pays for most hospitalisation costs, including visits to the emergency room and cares from an inpatient specialist once you’re admitted to a hospital. All inpatient care under Part A is free at all hospitals that accept Medicare patients. This includes treatment for vision problems. Part A doesn’t cover the cost of surgery or eye surgery. But it does cover emergency care for all diagnoses. However, you will have to pay a copayment or coinsurance if you choose to go the route of outpatient care plans. The only exception to this rule is a covered vision-related condition, such as glaucoma or cataracts. If your doctor prescribes your eye surgery, then Part A coverage will pick up most of the cost of your prescription. If you are over 65 years old and living in an area where Part A is available, you will have a different prescription than if you weren’t living near a medicare coverage area. In this case, your prescription would be covered under your medicare part D programme.


Medicare Part B


Medicare Part B is used to cover the cost of treatment for various issues, including eye problems. With this part of your medical insurance, you’ll get help paying for procedures like cataract removal. You may have to make a copayment at first, but you’ll still receive the full amount of this procedure covered by your insurance programme. However, you won’t have to pay a copayment if you are eligible for free care under the Medicare Prescription Drug Programme (also known as Medicare Part D). When making your initial appointment with an eye doctor, this is something to know. You may be able to get treated without having to spend money on a copayment.


Medicare also covers eye exams at the time of your initial admission and each year afterward. You’ll also receive coverage for treatment for diseases of the eye, such as glaucoma and cataracts. Medicare does not cover treatment for the eye without a confirmed diagnosis of the condition. There are exceptions to this rule, so make sure to ask your doctor if you think they’re going to cover such treatment. You can also ask any eye specialist if they accept medicare patients.


Medicare Part C


Medicare Part C is known as the Medicare Advantage plan. You can receive services from any option: doctor, hospital, pharmacy, or home health agency. You can even receive treatment from an outside company if you don’t want to use the medicare advantage plan. Often, these plans will have their copayment or coinsurance fees, but with this add-on to your Medicare insurance plan, you’ll still receive coverage for a variety of different health problems. With an eye care-related problem, you can get help with the cost of your visit to an eye doctor for diagnosis and treatment. Medicare Advantage also covers services from home health care agencies if needed. You can receive services at a doctor’s office, a hospital, or even at a retail store. The only thing you will have to pay for is the medication prescribed by your eye doctor. You won’t have to pay anything if you are under 65 years old.


Medicare Advantage is a good choice for older adults who don’t have vision insurance but have other types of coverage, such as traditional medicare or private insurance. There are many benefits to enrolling in this program, including coverage plus lower out-of-pocket costs and longer doctor’s visits without the need to get prior authorisation. When you sign up for medicare advantage, you can choose from a different plan list that provides extra benefits. These plans include things such as discounts for eyeglasses and prescription drugs. You can also choose a plan that covers all of your eye care needs, as long as you have medicare and traditional medicare. If you’re interested in enrolling in a plan, ask your doctor what type of health insurance they recommend.


Medicare Part D


Medicare Part D is also known as the prescription drug programme. This helps members of medicare 65 and older pay for medications, including eye drops. With this programme, you’ll have a separate prescription drug coverage each year and at no cost to you. However, if you have other insurance plans that cover your prescription, they will be considered. If a different plan covers the cost of your prescription drops, then this part of your insurance programme won’t cover it. You’ll have to pay for the cost on your own.


Medicare covers eye care promoting eye emergencies and major surgery, but they don’t cover routine tests such as eye exams and contact lenses. If you have medicare, your eye doctor will have to submit a form to your insurance company that states they are treating you. This doesn’t mean the programme always covers them, but it does mean that if you qualify, medicare will cover whatever type of treatment your doctor recommends.


With Medicare Part D, there is no copayment at all for patients over 65 years old. However, there is no coverage for glasses and contact lenses, only for the prescription drugs included in the programme. So if you need a pair of glasses, you’ll have to pay for them yourself. But if you are over 65 years old, if you qualify for medicare, you’ll have your prescription drugs covered by your insurance programme. If you are 55 years old or older and living in an area where Medicare Part D is available, ask when your first prescription is due. If it’s at least seven days later, they will automatically send the drug to your pharmacy. This means you won’t have to worry about paying out of pocket for a needed prescription. Your insurance programme will cover it under the monthly premium that you pay.




Eye care is an important part of overall health, so it’s important to ensure that you receive the proper treatment and services. If you have any questions regarding Medicare coverage ask your doctor or Medicare professional from ClearmatchMedicare. They will explain what type of coverage options are available for eye care.