Unfortunately, routine eye exams (sometimes called "eye refractions") that test for eyeglasses or contact lenses are normally not covered under Original Medicare. (Coverage is available through a number of Medicare Advantage Plans, but more about that later.)
Most major vision care procedures are covered, including cataract surgery, treatment of eye diseases and medical emergencies. Original Medicare will also pay for exams to test for other problems like macular degeneration, dry eye syndrome and eye infections.
Original Medicare provides coverage for eyeglasses following cataract surgery and contact lenses if the lens were inserted during cataract surgery. Medicare will not pick up the extra cost if you choose a specialized lens that restores full range of vision in order to reduce your need for glasses after cataract surgery.
If you have diabetes or are at high risk for glaucoma you will be covered for an annual exam. People at high risk include diabetics, those with a family history of glaucoma and older Hispanics and African-Americans.
So are there other options? There are a number of Medicare Advantage plans that include vision coverage as part of their plan. If you know you are going to want to visit your eye doctor every year, it’s a good idea to consider one of these plans instead of Original Medicare. In addition to covering a percentage of the cost of exams and eyeglasses, many of these plans include dental, hearing and prescription drugs coverage.
Another option is to purchase a Medicare Supplement, sometimes referred to as Medigap Insurance. A Medicare Supplement will cover your out-of-pocket costs for approved Medicare vision procedures. Remember, Original Medicare does not consider routine eye exams and prescription glasses to be approved expenses.
Military veterans who are visually impaired may be eligible for the VA’s vision health benefits. These range from primary care services to intermediate and advance clinical vision care. If you qualify for veterans benefits, check with your local VA Medical Center for more details.
If you would like to learn more about insurance plans that cover vision care, hearing or dental costs, please contact me at 440-255-5700. Open enrollment begins October 15 and is a good time to take a look at your options for 2016 to find a plan that fits your needs.