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What does medicare pay for vision care?

Health is the most valuable thing that every person has. You have to look after yourself in order to live happily ever after. You should maintain your physical and psychological health. And one of the most important aspects of physical health is vision. And we all know that no matter how well we take care of our vision during life, it will still begin to fall with age. So, after 40, many people begin to lose their eyesight and to preserve it, they need to pay more attention to it.

Very often, people’s vision problems begin to appear long before the age at which they should. It happens due to an incorrect lifestyle, poor living conditions, and rare vision checks. According to statistics, presbyopia is the number one eye disease among Americans aged 41 to 60 years and older. With this disease, it becomes more difficult for a person to view objects at a close distance. You should start worrying about the state of your vision if you are inherent in anything from the list below:

  • You have a chronic medical condition, including diabetes or high blood pressure;
  • Your ancestors had diseases such as glaucoma and macular degeneration;
  • Your health condition is not at the highest level due to constant anxiety, stress, depression, or thyroid disease;
  • You have taken or are taking medications that may harm your vision.

Even though vision is an essential part of our life and we need to take outstanding care of it, Medicare usually does not cover its treatment. But do not be in a hurry to get upset because some parts of Medicare may still partially cover the care of your eyesight.

Medicare and eye exams

Vision plays a significant role in every person’s life, especially with age, when it begins to deteriorate, and you need to monitor it more closely and check its condition more often. And many Medicare participants are surprised that this program does not support standard vision exams at patients’ request. Yes, the Medicare program only pays for vision checks in connection with complaints about its sharp deterioration, injury, and so on. Therefore, you cannot undergo a vision examination under this program whenever you want unless you pay for it yourself.

Also, if you come for an examination and have any diseases, then Medicare will still not pay for this appointment, but the program will cover all subsequent appointments and treatment.

Original Medicare plans

Not all Medicare programs cover eye examinations. For example, the Medicare part B program covers only medically necessary eye examinations prescribed directly by a doctor and some way or another related to other wellbeing issues, such as diabetes. It pays for diabetic retinopathy since it’s perilous and may even lead to blindness of patients with diabetes.

Also, Medicare part B assumes 80% of the costs for glaucoma screening, but only for those who are at particular risk.

You can take a glaucoma test with 80% compensation if anything from the list below suits you:

  • You have diabetes;
  • Your relatives have or have had glaucoma;
  • You are African-American, and your age exceeds 50 years;
  • You are a Hispanic American, and your age exceeds 65 years.

It is also important to note that the original Medicare program pays for an eye examination only once every 12 months. Unfortunately, the program does not take on expenses the rest of the time, even in unforeseen situations.

Suppose you wanna check your eyesight for no apparent reason. In that case, you have to pay 100% of the amount out of your pocket since the original Medicare programs are not accepted in ophthalmological centers.

Medicare Advantage Plans

You can upgrade to the Medicare Advantage plan to get more convenience and more benefits, which gives its users more features and additional services than the original Medicare plans. Thus, if your plan includes the vision section, you can count on Medicare to pay part of the examination cost. The amount that the program pays for you directly depends on your plan and location.

Does Medicare cover eyeglasses and contact lenses?

Post-cataract services

If you have undergone cataract surgery, the program pays for your glasses or lenses (if your optometrist has a license to provide this). But it’s worth noting that this applies only to the classic frames of glasses and classic types of lenses.

The program would pay for your glasses and contact lenses even if you applied for support immediately after the operation. You can also be provided with both contact lenses for free, even if you have undergone surgery on only one eye.

Another important note: the suppliers you wanna order a product for yourself must be registered in the Medicare program. Only then your plan may cover the cost of glasses and contact lenses. Otherwise, you need to pay for what you want to order yourself.

Other cases

As with vision exams, the original Medicare programs don’t pay for glasses and contact lenses, which means that you must pay 100% of the cost of these things yourself. However, by participating in Medicare Advantage programs, you can count on the cover the costs of purchasing glasses and contact lenses. Some Medicare Advantage plans pay only 20% of the expenditure, some 50%, and some programs can pay 75% or even 100%. We recommend that you familiarize yourself with the program plans and find the most suitable option for you, which covers a convenient part of the cost of glasses and contact lenses.

What else does Medicare cover?

Medicare could cover the price of surgery to restore your vision if you lost it due to a chronic eye disease. You can count on a free vision examination if you have previously been diagnosed with any eye diseases. In emergency cases, for example, if your vision’s damaged due to a physical injury to the eye, Medicare also covers its treatment costs on its own.

Medicare will also pay for an eye prosthesis if you’re missing an eye for one reason or another, for example, because of surgical removal or congenital disability.

Eye diseases and injuries

Furthermore, Medicare covers the examination and treatment of the eyes for their diseases or injuries. If you medically need surgery or medication, then Medicare will cover these expenses in the following cases:

  • You are hindered by severe dry eyes or an allergic reaction to something;
  • Having congenital or acquired problems with the upper or lower eyelid;
  • Contracting an eye infection, such as conjunctivitis or barley;
  • Having diseases of the cornea of the eye;
  • Suffering from retinal detachment;
  • You have received a physical injury to your eye under any circumstances.

Macular degeneration

This disease is quite dangerous for people, as it can cause loss of central vision, which means that it will be much more difficult for a person to focus his eyes on objects directly in front of him. If you have this disease, then part of the Medicare program may cover a certain percentage of its treatment. It all depends on what specific program you belong to. Usually, program participants pay only 20% of the cost of all examinations, tests, and procedures.

Eye prosthesis

As in many other cases, you will need to pay only 20% of their original cost for procedures related to eye prostheses. The Medicare program covers the rest. Eye prostheses are provided to patients who have no eye due to congenital disabilities or have been surgically removed. The program also covers the cost of polishing the prosthesis and replacing it every five years.

LASIK

Laser-Assisted in Situ Keratomileusis is a reasonably popular operation to improve vision, which unfortunately is not included in any Medicare plans since it is not vital. You must pay for this operation yourself if you decide to do it. This operation is often not covered even by Medicare Advantage plans. However, before registering in any plan, it is better to check whether this is actually the case or not.

Vision benefits

Medicare part A

This plan covers the expenditure of your hospitalization and treatment in the hospital if you can’t receive treatment in a regular clinic and if you cannot have an eye operation there. You have to pay the deductible, and Medicare covers all further expenses. If you stay in the hospital for less than 60 days, then you won’t have to pay anything more and pay extra.

Medicare part B

This plan is not aimed at covering vision care and its examination, but it still covers part of the procedures for some groups of patients, for example, for diabetics. With this plan, you pay only 20% of the cost of procedures related to glaucoma, which develops against diabetes.

Conclusion

The eyes are one of the most important organs of the human body, without which its full-fledged existence is impossible. As you know, a person’s vision deteriorates over the years. The reasons for this are pretty different: diseases, injuries, incorrect conditions when reading, spending much time on gadgets and at the computer. To not go blind to old age at all, you need to regularly undergo eye examinations and monitor the state of your vision.

Medicare programs can help you with this by taking part in the examination fee and various procedures. The original programs mainly cover only emergency cases and necessary surgery, while the Medicare Advantage programs cover a much greater variability of services. In both cases, the standard amount of cost coverage is about 80%. In some cases, it can be more, reaching even 100%. You’ll discover more accurately almost the sum of coverage for the taken a toll of vision treatment directly when choosing a Medicare program.