Medicare covers vision services if it’s deemed medically necessary. For many beneficiaries, their vision is medically essential to them, but Medicare doesn’t see it that way.

Does Medicare Cover Vision?

Original Medicare won’t cover routine eye examinations, treatments, or glasses unless tied to a medical condition. Medicare Part B will cover routine preventative and diagnostic eye examinations for diabetes, glaucoma, macular degeneration, and cataracts.

Diabetes

Diabetic retinopathy damages the retina in the back of the eye and is caused by diabetes mellitus. It affects 80% of people that have had diabetes longer than 20 years and is one of the leading causes of blindness in developed countries.

Medicare will cover diabetic retinopathy once a year for beneficiaries that have diabetes.

What Causes Diabetic Retinopathy?

Damage to the blood vessels of the sensitive tissue in the retina is the root cause of diabetic retinopathy. Diabetes type 1 or type 2 can both lead to diabetic retinopathy.

Am I At Risk For Diabetic Retinopathy?

Anyone with diabetes is at risk for diabetic retinopathy. The less control you have over your blood sugar, and the longer you have diabetes, the more likely you’ll develop diabetic retinopathy.

What Steps Can I Take To Prevent Diabetic Retinopathy?

You can help prevent diabetic retinopathy by lowering your sugar, fat, and salt intake by eating a healthy diet.

Living a healthy lifestyle by exercising regularly and staying within your BMI for your body type.

Do you smoke or drink alcohol? Cutting these two items from your daily life will lower your chances of diabetic retinopathy.

Regular monitoring of your blood sugar will help you keep from developing or keep control of your diabetes.

Glaucoma

Glaucoma is a group of eye diseases that causes vision loss due to damaging the optic nerves.

Beneficiaries with a high risk of glaucoma will be entitled to receive a glaucoma test every 12 months.

What Causes Glaucoma?

The leading cause of glaucoma is an accumulation of fluid in the eyes, leading to built-up pressure to the eye, and this causes damage to the optic nerve.

Am I At Risk For Glaucoma?

Those considered high risk for glaucoma falls into 3 categories: genetics, age, or unnatural effects.

Suppose you have a family history of glaucoma. In that case, those over 60 years old, frequent steroid users, including inhalers used to treat breathing conditions, and those with past eye injuries have a higher risk of developing glaucoma.

People of Hispanic, Asian, or African American descent are at higher risk for developing glaucoma.

What Steps Can I Take To Prevent Glaucoma?

Regular eye exams are the best form of prevention, as early detection and treatment can lower the effects. A typical moderate workout routine can help reduce the pressure in the eyes. Protect your eyes when playing sports or projects that could cause eye trauma.

Macular Degeneration

Macular degeneration is an eye condition that can cause blurry or no vision in the center of the visual field. At first, there are no symptoms, but beneficiaries report worsening vision in one or both eyes as the disease continues.

While macular degeneration will not lead to being completely blind, it can affect your ability to complete simple everyday tasks. Medicare will cover diagnostic testing for both wet and dry macular degeneration.

What Causes Macular Degeneration?

The leading causes of macular degeneration are fatty deposits and oxidative stress.

Am I At Risk For Macular Degeneration?

Macular degeneration risk factors include age, gender, genetics, smoking, sunlight, blue light, medications, eye color, diet, and cardiovascular disease.

Women have a slightly higher risk of developing macular degeneration. Those of Caucasian descent and a family history of macular degeneration are at higher risk.

Anyone over the age of 60 is at risk of macular degeneration. This is compounded if you meet any of the risk factors mentioned above.

What Steps Can I Take To Prevent Macular Degeneration?

Eating foods that clear fats, provide antioxidants, and help with blood flow and cellular health.

Some of these include:

  • Fruits high in vitamin C
  • Dark green, bright yellow, or red vegetables
  • Omega 3 heavy foods such as fish
  • Eggs in moderation
  • Dark Chocolate

Cataracts

Cataracts are cloudy areas in the lens of your eye and are very common as you age. Over half of Americans over age 80 have cataracts or have had cataracts surgery to get rid of the condition.

Similar to macular degeneration, you may have no symptoms early on. Over time cataracts will make your vision hazy, less colorful, or blurry. This can cause issues with reading and other everyday activities.

Cataract diagnostic testing and surgery to replace cataracts are covered by Medicare.

After cataract surgery, Medicare will help pay for corrective lenses. This includes one pair of eyeglasses with standard frames or one set of contact lenses.

What Causes Cataracts?

Cataracts are due to the proteins in the lens of their eye breaking down or clumping together. This increases over time, making the vision worse.

Am I At Risk For Cataracts?

As you age, your risk of cataracts increases, and this can be further escalated by smoking drinking alcohol.

In addition to the above, having a former eye injury, radiation treatment of your upper body, too much time in the sun, or taking steroids.

What Steps Can I Take To Prevent Cataracts?

You can take steps to decrease your chances of getting cataracts by wearing sunglasses. You can also wear a hat with a brim to block the sun. If you’re a smoker, quit smoking, Medicare covers smoking cessation services. A healthy diet with plenty of fruit and vegetables, especially dark, leafy greens.

Costs of Medicare-Covered Eye Conditions

Medicare-covered eye services are covered under Medicare Part B. First, you meet your Medicare part B deductible. Once that’s satisfied, you’re responsible for 20% of the Medicare assigned cost and up to 15% of excess charges.

Suppose you’re enrolled in a Medigap plan. In that case, you’ll have little or no out-of-pocket expenses for Medicare-approved vision services. This will depend on the plan letter of your Medicare Supplement plan.

When enrolled in a Medicare Advantage plan, you’ll be held to the plan’s terms and conditions. This will typically be a fixed copay for the services.

FAQs

Does Medicare pay for vision care?

If you have a prevailing health condition that Medicare deems essential to protect your eyes, the answer is yes. But for normal Medicare beneficiaries, Original Medicare doesn’t cover vision care. This means you’ll need to purchase supplemental coverage to enjoy vision care.

How often will Medicare pay for glasses?

Medicare will pay for a pair of glasses for someone who’s undergone surgery to correct their vision. But it is usually a one-time thing with Medicare. You or your supplemental health insurance cover subsequent pairs of glasses or contact lenses.

Does Medicare Part B cover eye exams?

If you suffer from one of the above-listed maladies, the answer is yes. Outside of that, the answer is no.

How to Get a Medicare Plan that Covers Vision Care

Many Medicare Advantage plans have preventative and basic vision services, in addition to those conditions mentioned above. And if you’re looking for vision care, we know this is an extremely important decision for you.

We can help you find a comprehensive Medicare plan to cover your medical and vision needs. Give us a call or fill out our online request form. We would love to help you see what’s available in your area.

Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.