Medicare Benefits for Eye Exams and Glasses for Diabetics
Diabetes is a chronic disease that prevents glucose (blood sugar) from entering the cells and providing fuel to the body. The pancreas produces insulin to drive this function.
The absence or insufficient amount of insulin prevents glucose from doing its job, leading to severe health conditions affecting your heart, blood vessels and nerves. Type 2 is the most common type of diabetes.
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Medicare Benefits Solutions
Apr 13, 2022
Diabetes and Eye Problems
If you have diabetes, your eyes are at risk for blurry vision, cataracts, glaucoma, diabetic retinopathy and other eye diseases. WebMD reports that among adults ages 20 to 74, diabetes is the primary cause of blindness.
The National Eye Institute explains that “the damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well.”
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Prevalence of Diabetes
Over the past few decades, the World Health Organization (WHO) has reported a steady increase in people with diabetes. According to WHO statistics, 422 million people worldwide had diabetes in 2014, up from 108 million in 1980, and the disease is a significant cause of blindness.
Screenings, treatment and lifestyle changes can help:
- Following a healthy diet
- Increased physical activity
- Prescribed medications
- Regular checkups including a diabetic eye exam
Eye Exams for Diabetes
The American Academy of Ophthalmology (AAO) calls attention to the unique eye care needs of people with diabetes, even if your blood sugar is closely monitored and under control.
AAO guidelines for diabetic eye exams:
- Type 1 diabetes: within five years of the onset of diabetes
- Type 2 diabetes: immediately following the diagnosis at any age, following your ophthalmologists’ recommendation after that
Types of eye testing:
- Eye muscle to check for weakness, diminished control or lack of coordination
- Visual acuity to check if you see clearly
- Refraction to determine if you need corrective lenses or a corrective lens adjustment
- Perimetry to test your field of vision
- Color vision to detect color blindness
- Slit-lamp to uncover damaged cells
- Retinal to assess the back of your eye
- Tonometry to measure fluid pressure, which can reveal signs of glaucoma
Does Medicare Cover Vision Care for Diabetics?
Generally, Medicare does not offer benefits for routine vision exams or exams needed to get a prescription for eyeglasses or contacts. Many Medicare recipients who want vision care included in their healthcare coverage choose to enroll in a Medicare Advantage (MA) plan.
MA plans are an alternative to Original Medicare. They are required to include at least the same Part A and Part B coverage of Original Medicare, but many plans include additional benefits, such as routine vision and dental care, prescription drug coverage, and fitness programs.
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Are Diabetic Eye Exams Covered by Medicare?
If you have diabetes, Medicare Part B covers an annual exam for:
- Diabetic retinopathy
If you have diabetes, Medicare pays for diabetic eye exams up to 80% of the Medicare-approved amount. You are responsible for the 20% coinsurance and the Part B deductible ($233 in 2022).
If you do not have diabetes, you may still be eligible for glaucoma annual screenings if you:
- Have a family history of glaucoma OR
- Are at least 50 years old and African American OR
- Are age 65 or older and Hispanic
Does Medicare Pay for Glasses for Diabetics?
The fact that Medicare covers a diabetic eye exam begs the question, “Does Medicare cover the cost of glasses for diabetics?” Medicare coverage of corrective eyewear is limited to those who have cataract surgery with intraocular lens implantation. To take advantage of this benefit, using a Medicare supplier is mandatory.
You are responsible for 20% of the Medicare-approved amount and the Part B deductible applies for corrective lenses you receive after these surgeries. If you want upgraded frames, you are responsible for paying any additional costs.
Symptoms of Diabetic Eye Diseases
A preventive eye exam is critical because you may not have any symptoms in the early stages of diabetic eye disease. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) outlines the symptoms you may experience at some point:
- Blurry or wavy sight
- Daily or frequency changes in your vision
- Loss of vision or areas that appear dark
- Reduced color vision
- Floaters (may appear as spots or strings floating in front or sides of your eyes)
- Light flashes
Free Eye Exams
Suppose insurance does not cover your eye exam. In that case, you might look into a program called EyeCare America, which is staffed by volunteer ophthalmologists across the U.S. With an emphasis on early detection, EyeCare America is a public service organization.
The two programs offered to U.S. citizens and legal residents are available to people with no HMO or VA benefits. One is a senior program for adults aged 65 or older, and the other is a glaucoma program for people at risk for glaucoma who have not had a vision exam for more than a year. To check your eligibility, call 877-887-6327 or email [email protected]