Does Medicare Cover Vision, Eye Exams, Glasses, and Cataract Surgery

Taking care of your vision is probably one of the most important things in our daily lives but dealing with vision care can seem like a hassle. 

What if I told you that figuring out what Medicare covers when it comes to vision isn't hard at all. 

Today I will answer the question does medicare cover vision and also discuss things like eye exams, glasses and cataract surgery.

does medicare cover vision

Does Medicare Cover Vision

Medicare doesn’t cover any form of vision when it comes to everyday routine coverage.

If you need eyeglasses or contact lenses, you are probably going to need to look at a company that sells vision care. 

With that being said, they do, however, cover specific help with eyecare if you have had a cataract surgery that implants an intraocular lens. 

If this happens, Medicare will pay to cover a corrective lense, one pair of eyeglasses or one set of contact lenses.

Medicare will only pay for standard frames so you won’t be able to get something fashionable. 

You will also qualify for this coverage if you had cataract surgery before you had Medicare.

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And guess what: 

Even if you only have the surgery on one eye, both eyes may still be covered for contacts or glasses. 

The only downside to this is that the entire process is managed by Medicare, which means: 

  • You need a prescription order signed by your doctor (ophthalmologist or optometrist) and on file with the supplier.
  • Suppliers must be enrolled in Medicare and must meet strict standards to qualify for a Medicare supplier number.
  •  Medicare won’t pay your claim if your supplier doesn’t have a number, even if your supplier is a large chain or department store that sells more than just durable medical equipment (DME).

After the cataract surgery, you will be responsible for a 20% co-pay on one pair of eyeglasses or one set of contact lenses after the Part B deductible if you haven’t paid that yet.

If you decide you would like to upgrade your frames, you will be responsible for the difference in cost of anything over the price of a standard eyeglass frame.

Now, keep in mind: 

If the supplier isn’t part of Medicare, you need to find a supplier that is because Medicare will not cover you for lenses from a supplier not in their plan.

Does Medicare Cover Routine Eye Exams

As we stated above, routine eye exams are not covered by Medicare.

However, they will cover some preventative eye tests and screenings, like glaucoma and macular degeneration.

You will pay 100% out-of-pocket with Original Medicare for routine eye exams.

Will Medicare Cover Glaucoma Screening

You can get a screening for your Glaucoma test covered once per year if you are at high risk for glaucoma. 

So, for people with: 

  • Diabetes  
  • Family history of Glaucoma
  • African Americans who are age 50 or older
  • Hispanic Americans who are age 65 or older
  • List Element

The screening has to be done by or supervised by an eye doctor who is legally allowed and able to do the service in your state.

You pay 20% of Medicare-approved amounts, and the Part B deductible applies.

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Does Medicare Cover Cataract Surgery 

Medicare does cover cataract surgery under Part B of Medicare as an outpatient service.

It will cover: 

  • The removal of the cataract 
  • Basic lens implants
  • One set of prescription eyeglasses or one set of contact lenses

Although Medicare covers primary lens implants, it does not cover more advanced implants.

Like other procedures, you will be required to cover the 20% co-pay for any of these services.

Will Medicare Cover Macular degeneration 

Depending on your situation, some people who have age-related macular degeneration are covered by Medicare for both treatment and tests.

You would be responsible for the 20% deductible when it comes to payments for any of those services.

Depending on your situation, some people who have age-related macular degeneration are covered by Medicare for both treatment and tests.

You would be responsible for the 20% deductible when it comes to payments for any of those services.

Does Medicare Cover Eye prostheses 

If you have an absence or shrinkage of an eye due to a birth defect, trauma, or surgical removal then medicare will cove your eye prostheses.

Medicare will cover the polishing of an artificial eye and usually replacement in every five years. 

You will be required to cover the traditional 20% co-pay for any of the services. 

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Take Action!  

As you can see, it really depends on your specific situation if Medicare will cover your vision care. 

There are also instances where a Medicare Supplement plan can help.

Senior Benefit Service has been in the Medicare business for over 50 years and understands your concerns.   

To make sure everything is understood correctly, give a Senior Benefit Expert a call today!