Does Medicare Cover Vision and Eye Care?

Medicare is a health insurance program run by the United States government, and it primarily covers individuals at least 65 years old. While a government program, insured individuals do bear some of the cost. Also, the program only covers some things. Determining eligibility, costs, and coverage can be a complex process for anyone registering for the program. Many wonder if Medicare covers vision and eye care, and the answer in most cases is simply no. This coverage must be arranged separately unless you fall into one of the exception categories, but those are usually narrow in focus.

Eye and Vision Care

Original Medicare coverage doesn’t cover routine eye care services, and regular eye exams are a part of that. On the other hand, Medicare will cover specific eye care services for individuals with chronic eye conditions. These include glaucoma and cataracts.

One thing that Medicare will cover is an eye exam used to diagnose possible problems with your vision. In cases where a Medicare recipient has vision issues that suggest a serious eye complication, the program’s coverage will provide for a fully covered exam even if the eye doctor doesn’t identify any specific vision issues.

A second thing that the program will cover is surgical procedures used to repair eye function if chronic eye conditions are causing issues. For instance, the program will provide coverage for surgery that removes cataracts. These surgeries often involve replacing the eye’s natural lens with an artificial intraocular lens.

If you need a fabricated intraocular lens after cataract surgery, then the third thing the program covers is contacts or eyeglasses. Should you need them, Medicare covers a standard pair of contacts or untinted prescription eyeglasses. In cases where doctors deem customized contacts or eyeglasses medically necessary, the program might pay for those.

Exceptions for Two Diseases

Coverage through the Medicare program will only cover routine eye care in two circumstances. First, you can get regular eye care covered if you are diabetic. Second, you can qualify for Medicare routine eye care coverage if you are at a high risk of developing glaucoma.

Diabetes is a long-lasting or chronic health affliction that impacts how the human body converts food into energy. Your body will break down most of your food into glucose, more commonly known as sugar, and then release that into your circulatory system. As your blood sugar levels rise, your body will instruct your pancreas to start releasing insulin. This essential hormone is crucial to your body’s many cells using blood sugar as energy. Diabetics don’t produce the levels of insulin they need, or they don’t use it efficiently. When blood sugar remains in the circulatory system too long, it leads to serious health issues. They include kidney disease, heart disease, and loss of vision. Medicare coverage for diabetics allows government-authorized eye doctors to look for vision problems related to the disease.

Medicare recipients at high risk for glaucoma are covered for annual eye exams given by authorized doctors. The criteria for being classified as high risk include having diabetes, a known family history of diagnosed glaucoma, and either being Hispanic over the age of 65 or African-American over the age of 50. In this disease, damage happens to the optic nerve in your eye. This typically occurs after fluid accumulation in the front of the eye. The excess fluid puts too much pressure inside the eye, and the optic nerve is consequently damaged. Glaucoma is the primary reason people over the age of 60 go blind, but early treatment can prevent it from happening.

Standalone Vision Plans

If your Medicare coverage doesn’t include a vision plan, you can always get a private plan on the open market. Some plans through the Health Insurance Marketplace created with the Affordable Care Act include adult vision coverage, but not all do. You can also get vision coverage as a standalone plan by itself. Use an insurance broker, contact companies individually for quotes, or consult an insurance agent. Your state should have a department of insurance that can guide you to possibilities, and your doctor can likely refer you or connect you to valuable resources.

Why Vision Care Matters as You Age

As people age, the chances of various physical conditions rise. Many can result in eye health issues, but routine eye care appointments can identify and treat many problems before they become disabling. Low vision in seniors hurts their quality of life, and they might have trouble doing daily activities such as reading, cooking, and driving. Losing mobility and becoming dependent on those around you can even lead to depression. Vision insurance and taking care of your eyes helps you maintain independence as long as possible, and the right coverage might cover specialized aids and devices that make the most of your remaining vision.

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