Does Medicare Cover Eye Exams?
When you sign up for Medicare you may assume that all of your health concerns will be covered, but there are several areas of healthcare that Medicare does not cover, or it only covers them in a few instances. As you get older you may need glasses as your eyes go soft. There are all sorts of eye problems that happen when you age that might cause you to need glasses, the most common of which is simply that your vision gets worse over time. If you want to get glasses you may have wondered if Medicare covers that, or even an eye exam. The answer is here for you to find out.
So, Does Medicare Cover Eye Exams?
The simple truth is that Medicare doesn’t really cover anything related to your vision health. This is for people who sign up for Medicare Parts A & B and is considered to be “original” Medicare. If you are at risk for glaucoma or some other eye diseases, Medicare will authorize a vision exam every 12 months. If you’re not, you won’t get this vision exam from Medicare.
However, if you decide to sign up for a Medicare Advantage Plan as part of Medicare Part C, you will notice that you can get certain plans that have vision coverage. You will almost certainly pay an extra premium for this privilege of having vision coverage as part of your Medicare coverage. So, if you only have original Medicare and you want to get an eye exam, eyeglasses, or contact lenses, you will not have any type of coverage. The only time Medicare will cover actual eyeglasses is if you require corrective lenses to correct a problem due to another medical problem or procedure.
Other Vision Problems
Luckily Medicare covers other vision problems. If you have diabetes and are at higher risk for glaucoma, they will offer you screenings. If you are in need of a fake eye AKA an eye prosthetic they will cover that, and will offer you a replacement every 5 years. Medicare also covers care for your fake eye including polishing so it stays looking great.
Cost of Eye Exam & Glasses
If you have Medicare and you want to get vision related services, you will almost definitely have to pay out of pocket. So, how much does this stuff cost anyways? If you go to a general eye doctor you can expect to pay around $50 for an exam, however there are cheaper options and there are certainly more expensive options as well. Eyeglasses also range in cost from $150 to upwards of $500. If you are of a lower income and you can not afford glasses you may be eligible for Medicaid, the health care program for low-income Americans which does actually cover eyeglasses and eye exams.
Does Regular Health Insurance Cover Eye Exams?
Regular health insurance plans also do not tend to cover eye exams. Some employers offer separate vision insurance that will help you to cover that. However, the average person just ends up paying for this type of thing out of his or her own pocket. It really is a challenge for some people because if their glasses break they might not have enough money to replace them and having health insurance companies cover glasses might make things easier for some people. Luckily thanks to the Affordable Care Act, all health insurance plans must now include health insurance coverage for children. This is great because having glasses if needed can make a big difference in the education of a kid, which can have life long positive effects.. However, adults will still have to pay out of their own pocket for their glasses.
So, in conclusion, Medicare doesn’t cover eye exams for glasses. But, if you need an eye exam or glasses due to another procedure or condition, it will. This is pretty rare and is usually activated if you are at risk for glaucoma or another eye condition. Luckily, if you get a Medicare Advantage plan you might be able to get some vision coverage by paying a bit more for your Medicare. You can also get some coverage through Medicaid if you have a low enough income. Get the facts and know your rights to receive the best coverage with the least effort!