The health of your eyes and your vision is important to your standard of living. It’s one of our five key senses, after all. With many seniors facing vision loss from some sort of cause, and the number expected to grow to 70 million by 2030, it’s likely that many of us will face some sort of vision struggle in our lifetimes. This makes preventing issues and finding affordable treatment options, for any vision concerns that may pop up, extremely important.
If you’re on Medicare, either through Original Medicare or Medicare Advantage, you’ll have many health care options covered by the your plan. Unfortunately, with vision coverage, that’s not 100 percent certain. So, what types of services are covered, and which aren’t?
Routine Checkups and Lenses
A few times in the past, we’ve discussed Medicare’s coverage, or lack thereof, regarding routine vision checkups and lenses. Generally speaking, Original Medicare doesn’t cover routine eye checkups. It also doesn’t cover contact lens and eyeglasses. The lack of coverage for checkups makes sense when you consider they’re usually for contact lens and eyeglass fittings, not for medical purposes.
Generally speaking, Medicare doesn’t cover routine eye checkups, but there are a few ways to get them covered.
There are a few ways regular vision checks can get covered. For example, if you’ve just signed up for Original Medicare, a routine eye exam is also often included in your Welcome to Medicare visit. If you’re curious about exploring ways to get your exams checked, we encourage you to talk to an independent licensed agent.
Age-Related Macular Degeneration
When it comes to preventing and treating common vision conditions, the Medicare program is a little more comprehensive. This is especially true for macular degeneration, the most common cause of vision loss in the United States. Macular degeneration is when part of your retina is damaged, impairing your central vision. While there’s no cure for macular degeneration, you can treat it to prevent further damage or potentially reverse some of the blurriness.
Not only does Medicare insurance cover macular degeneration diagnostics tests, it can help with medically necessary treatments.
This is where the Medicare program can help. Not only does Medicare insurance cover diagnostics tests for macular degeneration so you can catch the condition early, it can help with medically necessary treatments. This includes treatments that include certain injected drugs, too. If you qualify for Medicare insurance coverage with macular degeneration, you’ll pay 20 percent of the amount for the drugs and services, or a copayment in a hospital outpatient setting. Your Medicare Part B deductible also applies.
Another common condition that causes visual impairment is a cataract. By age 70, more than 30 percent of seniors have cataracts. Cataracts are cloudy spots on the lens of your eye which can cause blurriness, weaken night vision, and even cause blindness if left unchecked. They’re caused by the breakdown of tissue in the lens of your eye. Often, this is the result of aging, but injuries and illnesses can also cause cataracts.
By age 70, more than 30 percent of seniors have cataracts.
Usually, treatment for cataracts isn’t necessary, since you can easily live with cataracts through a combination of prescription glasses and lifestyle changes. If they progress to the point where treatment becomes necessary, cataract surgery is an option. Luckily, if you need cataract surgery, Medicare insurance will likely cover you. In these cases, Medicare insurance covers the surgery, while you’ll owe 20 percent for the corrective lens that are part of the surgery. Your Part B deductible will also apply. The Medicare program only covers the lens if the supplier is enrolled in the Medicare program. You or a supplier can’t submit a claim later.
Glaucoma is a group of conditions that cause visual impairment and blindness by damaging your optic nerve. Roughly three million Americans live with glaucoma, making it the leading cause of irreversible blindness in the world. What makes glaucoma so damaging is that it often presents no symptoms in early stages, which is why it’s called the “silent thief of sight.” By the time symptoms are present, the damage may have already been done.
Glaucoma often presents no symptoms in early stages, which is why it’s called the “silent thief of sight.”
Early detection is critical for treating glaucoma. To assist with this, Medicare insurance covers an annual glaucoma screening if you’re in a high-risk population for glaucoma. You’re considered high-risk if:
- You have diabetes
- You have a family history of glaucoma
- You’re African American and aged 50+
- You’re Hispanic and aged 65+
If you fall into these categories, Medicare insurance will cover all but 20 percent of the exam, with the Part B deducible applying, and a copayment if in a hospital outpatient setting. If glaucoma is found, surgery may be necessary. If your doctor decides that glaucoma surgery is medically necessary, it may be covered by Medicare, though this may be a case-by-case condition. Other treatment options include medications, which may be covered by a prescription drug plan like Medicare Part D.
If you have diabetes, complications with your vision and eyes is not only possible, it’s common. This is called diabetic retinopathy, which is caused by damage to the light-sensitive tissues in the retinas. Similar to glaucoma, early stages of the condition rarely produce symptoms, but eventually, you may have blurred or fluctuating vision, dark areas in your sight, or even vision loss.
Medicare insurance can cover an annual screening for diabetic retinopathy if you have diabetes.
To combat the risk of vision loss in diabetic patients, Medicare insurance can cover an annual screening, like for glaucoma. This exam is only covered if you have diabetes. You’ll also owe 20 percent of the costs of services and a copay in an outpatient setting. A Part B deductible applies. Medically necessary treatments may be covered depending on circumstances, whether that treatment is medicinally or surgical.
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If you’re struggling with vision impairment or loss, monitoring or treating your condition can be essential to ensuring your ability to maintain your standard of living. With the help of your Medicare insurance coverage, this monitoring and treatment may become affordable, removing at least one concern and helping you focus on enjoying your life!