Does Medicare Cover Vision Care for Diabetics?

Medicare Benefits Solutions
Sep 16, 2021

Does Medicare Cover Vision Care for Diabetics? For people living with diabetes, vision care is extremely important. High blood sugar levels can raise the risk of eye and vision problems like cataracts, glaucoma, retinopathy, and blurred vision.

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Diabetes Vision Facts

Diabetes is the main cause of blindness in adults who are between the ages of 20 and 74. And diabetic retinopathy is the most common eye disease for diabetics.

Diabetic retinopathy is the result of changes in blood vessels in the retina. In some cases, the blood vessels become inflamed and leak fluid, while in others there is an abnormal growth of blood vessels on the retina’s surface.

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While diabetic retinopathy can’t be reversed, it can be treated so it doesn’t progress to blindness. That’s why it’s important for people with diabetes, pre-diabetes, and a family history of diabetes to take care of their vision in the following ways:

  • Visit the eye doctor at least one time every 12 months
  • Control blood sugar levels
  • Control blood pressure levels
  • Have cholesterol levels checked on a regular basis
  • Eat a healthy diet 
  • Quit smoking
  • Get exercise

Do Medicare benefits cover vision care for diabetics?

Medicare recipients who have coverage through Original Medicare Part B (outpatient medical insurance), have limited coverage for vision care if they have diabetes.

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Coverage for Diabetic Retinopathy

Part B Medicare benefits cover one annual eye exam for diabetic retinopathy if you have been diagnosed with diabetes. This exam must be done by an eye doctor who is licensed to perform these types of eye exams in your service area.

Medicare pays for 80 percent of the approved final cost of the exam. You are responsible for the remaining 20 percent as well as your Part B deductible. If you have the exam done as an outpatient in a hospital or other medical facility, you are responsible for the applicable copayment.

Coverage for Glaucoma

Medicare recipients who are at high risk for glaucoma have Medicare coverage through Part B for one glaucoma exam every 12 months. Medicare includes the following groups of people as high risk:

  • Those who have diabetes
  • Those with a family history of glaucoma
  • Those who are African American and 50 or older
  • Those who are Hispanic and 65 and older

Medicare pays for 80 percent of the approved cost of the exam once a year if it is done by a physician who accepts Medicare-assignment. You are responsible for the remaining 20 percent, your Part B deductible, and a copayment if done in an outpatient hospital setting.

Coverage for Other Vision Care Services

Medicare Part B also covers diagnostic exams and treatment for eye disorders and diseases if you have been diagnosed with age-related macular degeneration whether you are diabetic or not. Exams and treatments may not be limited to once a year depending on the progression of the condition.

Your physician must accept Medicare-assignment for Medicare to pay 80 percent of the cost. You pay the remaining 20 percent, Part B deductible, and copayment if applicable.

Does Medicare Advantage Offer Visioncare for Diabetics?

Medicare recipients with coverage through Medicare Advantage (Part C), have the same benefits as provided through Original Medicare Part A and Part B. Most Part C plans also include extra benefits that traditional Medicare doesn’t cover. In many cases, this includes vision care.
Beyond the basic benefits provided by Original Medicare for preventive or diagnostic vision services and treatments, many Medicare Advantage plans also cover the following vision care services, which are not limited to people with diabetes:

  • Routine refractive eye exams
  • Corrective lenses
  • Eyeglass frames
  • Fittings for frames and contact lenses

Some types of Medicare Advantage plans require that enrollees use health care providers, suppliers, and facilities that are included in the plan’s set network of providers. Before you make an appointment for an eye exam, make sure you know the details of your plan’s requirements.

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