Find Medicare Eye Doctors Near Me for Eye Exams and Glasses.
Medicare Benefits Solutions
Sep 9, 2022
As people get older, changes naturally occur, and none are more obvious than changes in eyesight. Of course, some vision problems are more common than others. Needing glasses to read or see things that are close, not being able to see differences in colors as clearly or adjusting to the light and dark more slowly are just a few things seniors notice.
Subtle differences in vision like these often become an accepted part of life. We adjust by getting reading glasses or turning on more lights in the house. But there are other vision or eye health issues that are more serious, and they must be diagnosed and treated by a physician or an eye doctor.
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Does Medicare Cover Eye Care?
After the age of 65, certain eye diseases and conditions such as age-related macular degeneration, diabetic retinopathy, cataracts, glaucoma, dry eye, and low vision become more common and increase the possibility of vision loss or blindness if they aren’t treated early.
Because these conditions don’t always have obvious symptoms in their early stages, it’s even more important for people 65 and older to get regular eye exams and to take extra care of their vision. If you have Medicare or will be eligible soon, you may be looking for eye doctors who accept Medicare.
Unlike some Medicare Advantage (Part C) vision care services that are often included within a plan’s additional benefits, Original Medicare Part B (outpatient medical insurance) doesn’t cover routine eye care services. Routine eye care may include services such as eye refractions, eyeglasses, or contact lenses (with limited exceptions). However, Medicare does cover certain eye exams and vision services in specific circumstances.
In certain instances, Medicare Part B may cover its share of the cost (80 percent) for visits to eye specialists, if your appointment is for a service that is covered by Medicare. The eye specialist, ophthalmologist, or optometrist must accept Medicare assignment for you to get this coverage.
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What Eye Examinations Does Medicare Cover?
If you have Original Medicare Parts A and B, your benefits cover the following eye examinations and treatment services:
Medicare coverage for glaucoma
Glaucoma is a serious condition that causes fluid to build up in the eye(s). It’s vital to diagnose and treat glaucoma early so it doesn’t damage the optic nerve and cause blindness.
Original Medicare Part B covers glaucoma screening one time every 12 months for those who are at high risk of developing it.
You may be at high risk for glaucoma if at least one of the following is true:
- You have a family history of glaucoma
- You are diabetic
- You are African American and 50 or older
- You are Hispanic and 65 or older.
To get this coverage, you must have your glaucoma screenings done by a health care provider who accepts Medicare assignment and is legally licensed to do them in your state of residence.
Original Medicare Part B pays 80 percent of the final approved cost for screenings and other treatment services. You are responsible for the remaining 20 percent after meeting your annual Part B deductible. If you have screenings, laser, or eye surgery to treat glaucoma done as an outpatient in a hospital, you may also be responsible for a copayment.
If your physician prescribes medication or prescription eye drops to treat glaucoma, you can get coverage through a stand-alone Medicare Part D prescription drug plan or Medicare Advantage plan that includes prescription drug coverage.
Medicare and age-related macular degeneration
Age-related macular degeneration is an eye disease that can occur when aging damages a part of the retina called the macula. The symptoms of macular degeneration depend on the type and the stage of the disease, but as it progresses, central vision becomes blurry, colors are muted, and you may have difficulty seeing in low lighting.
Original Medicare Part B covers diagnostic screening and treatment for age-related macular degeneration. Treatment is typically injections of prescription medication that your health care provider administers in her office.
Medicare and diabetes-related eye exams
Diabetic retinopathy is a condition stemming from diabetes that damages the retina of the eye(s) and can lead to blindness. If you have diabetes, either type one or type two, Original Medicare Part B covers screenings for diabetic retinopathy one time every year. The screenings must be done by an eye doctor that accepts Medicare and Medicaid and is legally licensed for these exams in your state of residence.
Medicare Part B covers 80 percent of the final approved cost of the above eye exams, and you pay the remaining 20 percent after meeting your Part B annual deductible.
Does Medicare Cover Cataract Surgery?
Cataracts, which are cloudy areas in the lens of the eye, typically develop slowly. Cataracts can form because of aging, trauma, diabetes, prolonged use of corticosteroid drugs, smoking, alcohol use, or prolonged exposure to strong sunlight.
If you have cataracts, you might have some of the following common symptoms:
- Colors appear to be faded
- Vision is blurry or doubled
- Seeing halos of light around objects
- Difficulty seeing in the dark
- Difficulty seeing in bright light
Medicare covers the following services and supplies for cataracts:
- Cataract removal surgery – either the phacoemulsification or the extracapsular procedure
- Intraocular lens (IOL) implantation
- One pair of prescription lenses – either eyeglasses or contacts – after the procedure
Original Medicare Part A covers your cataract surgery if you are treated as an inpatient in a Medicare-affiliated hospital. This is uncommon for cataract surgery, but if you need to be admitted for your procedure, you are responsible for paying your Part A deductible for the relevant benefit period.
Original Medicare Part B covers outpatient cataract surgery and doctor’s appointments. You must have the procedure done in a medical facility (hospital or clinic) that accepts Medicare assignment. Doctors/surgeons must also accept Medicare assignment for you to be eligible for the benefit.
Part B also covers one pair of eyeglasses or contact lenses if you have an IOL implanted. You must get them from a medical supplier who accepts Medicare assignment.
Medicare Advantage (Part C) offers the same coverage for cataract surgery as Original Medicare Parts A and B, but you may have different coinsurance or copayment costs. Your plan may also require that you use physicians, hospitals, clinics, and suppliers who are in the plan’s network of providers.
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Medicare Advantage Vision Care Services
Medicare Advantage (Part C) plans are sold by private insurance providers. They are required to provide, at minimum, the same benefits as Original Medicare Parts A and B. But Part C plans can also offer extra benefits such as dental, hearing, and vision care.
Today, most Medicare Advantage plans include routine vision care which can include the following services:
- Routine eye exams
- Corrective lenses for eyeglasses or contact lenses
- Frames for eyeglasses
- Examinations for eyeglass or contact fittings
- Some retinopathy procedures
- LASIK procedure if it is medically necessary
Your coverage for these services depends on the Part C plan you enroll in. Every plan has the option to cover these extra services, or not.
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How Can I Find Eye Doctors Near Me?
To find eye doctors or specialists near you that accept Medicare, you can use our plan finder tool. Simply type in your zip code and find plans that include vision care services.
Along with visiting your ophthalmologist or optometrist regularly, you can protect your eyes by doing the following:
- Wearing good quality sunglasses when you’re outside
- Quitting smoking or using other tobacco products
- Eating a healthy diet full of nutrients from fresh fruit and vegetables
- Engaging in physical activity every day
- Keeping your blood pressure at a healthy level
- Managing blood sugar levels
- Avoiding eye strain from too much screen time
Protecting your vision is vital to staying independent and healthy in your senior years, so it’s important to have information about how your Medicare insurance covers vision care services and how to find eye doctors who accept Medicare near you.
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