Eye exams are a common and important part of medical care for many people in Southern Nevada. Routine eye exams usually are not covered by Original Medicare. But if you are diagnosed with certain medical conditions, Original Medicare will cover some procedures to monitor your eye health.
However, you CAN choose Medicare Advantage plans that support your vision care needs.
Eye Exams and Vision Care Under Original Medicare
Medicare defines routine eye exams as those needed for glasses or contact lenses, also known as “eye refractions.” There’s no coverage for these under Part A or B.
Original Medicare does cover these services under Part B (Medical Insurance):
- Diabetic retinopathy exam, if you have diabetes (once a year)
- Glaucoma test, if you are at high risk (once a year)
- Tests and treatment for some eye conditions if you have age-related macular degeneration
- Corrective eyeglasses and contact lenses after some cataract surgery
Services under Part B Medicare are subject to a deductible, and you may also have to pay 20 percent (or another amount) for covered services under Original Medicare.
How Medicare Advantage Plans (Part C) Can Support Vision Care
Medicare Advantage Plans, also known as Part C Medicare, take care of many vision costs. The good news about Part C plans is that they are offered by a number of different private providers, which means you may have several options when it comes to choosing one that covers vision care.
Under most Medicare Advantage plans, you can get coverage for a routine eye exam that may include refraction and testing for glaucoma. These are typically performed by an optometrist or ophthalmologist. Coverage may also include eyeglasses, including frames and lenses, as well as contact lenses.
Your plan may cover more of the cost of an eye exam if you choose an eye doctor within the insurer’s network.
Medicare Advantage plans are of four general types.
- With a Medicare Advantage Health Maintenance Organization (HMO) or Special Needs Plan (SNP), you typically only receive coverage for services performed by in-network professionals.
- Medicare Advantage Preferred Provider Organization (PPO) plans offer greater reimbursement for services within the network. These PPO plans may have a higher cost and out of pocket expenses than the HMO or SNP plans.
- Private Fee-for-Service (PFFS) plans offer the greatest flexibility. These FFS plans also may have a higher cost and out of pocket expenses than the HMO or SNP plans.
The dollar amount of vision care coverage depends on your optional add-ons. You can typically add a supplemental vision care benefit to your Part C Medicare plan to get a greater eye care benefit.
Your Options if Medicare Won’t Cover Your Eye Exams
Even if you don’t have vision care as part of your Medicare coverage, you may still have access to reduced cost eye exams. Some private insurance providers have agreements with vision care brands to offer discounts on eyewear and optometrist visits. You can contact your Medicare Advantage insurer to learn more. Also, your eye care professional may choose to give discounts to seniors, even if you are living with Original Medicare only and typically would not have vision care costs covered.
How Eye Exams Help Support Seniors Healthcare
Although Original Medicare only offers limited eye exam coverage, eye care experts generally recommend regular eye exams for seniors. The American Optometric Association (AOA) says those over 60 should see their eye doctor once a year, to ensure early screening for eye diseases. Vision problems may arise due to a number of different factors, including hypertension and as a side effect of prescription medications. Staying on top of eye health can ensure continued quality of life, as you are better prepared to navigate changes in your vision.
Intermountain Health, and Senior Wellness
Medicare is complicated. Many people need assistance working through the system. At Intermountain Health, we’re here to help. We can tell you all you need to know about enrolling in Medicare products and programs, plus getting the right healthcare services and support. To take advantage of our broad network of 300 primary care providers and 1,500 specialists, call us at 702-852-9000. You can also RSVP to an upcoming educational event.
HCPNV has nearly 30 myGeneration clinics across Southern Nevada, providing innovative care for seniors. Here we provide a full suite of medical services to support your overall wellness. Talk to us today. We are dedicated to becoming your partners and advocates, as your health needs evolve and change.