Medicare covers millions of Americans for their primary health care insurance. Unfortunately, there is some confusion regarding whether Medicare covers eye exams and glasses or contact lenses.
Who is Eligible for Medicare?
Medicare is a health insurance program that provides insurance from the federal government.
The Medicare program is only available to those individuals who meet certain requirements.
Eligibility criteria for Medicare include being age 65 or older, receiving Social Security Disability benefits for two years, having end stage renal disease, or having amyotrophic lateral sclerosis (ALS).
The individuals who meet any of these criteria can receive the benefits provided from Medicare.
What are the Parts of Medicare?
Medicare is classified into different Parts which each cover different services.
Part A Medicare covers hospital-based services and hospital stays.
Part B Medicare covers non-hospital services, such as a doctor’s visits and outpatient therapy.
Part C Medicare is a part of the Medicare Advantage program to assist with copayment or coinsurance not covered by other parts.
Part D Medicare covers prescription drugs from an outpatient pharmacy.
It is important to understand the different coverage categories as the type of care will dictate what the amount of coverage is.
Will Medicare Cover an Eye Exam?
Medicare does not cover a routine vision exam or routine eye health exam without other conditions.
However, Medicare will cover an eye exam to address any medical complaint or an eye exam to evaluate certain medical conditions.
Medical Complaints and Conditions which Medicare Covers
There are many complaints which would allow an eye exam to be covered by Medicare. These include dry eyes, itching eyes, eye pain, glare at night, or blurry vision.
Medical complaints may require a complete eye exam or only require a problem focused eye exam depending on the condition and the complaint.
Conditions where Medicare will cover an eye exam without any other medical complaint include glaucoma, cataracts, macular degeneration, diabetes, and use of medications with known eye related side effects like hydroxychloroquine.
Does Medicare Cover Glasses?
While there are many cases where Medicare will cover an eye exam, there is only a single instance where Medicare will cover the purchase of glasses.
Medicare covers a single pair of basic glasses following cataract surgery. These glasses can be purchased within the year after the cataract surgery.
The glasses do not have to be purchased at the surgery site and in many cases, it is preferable to purchase the glasses at your optometrist’s office.
Other Medicare Programs
Medicare has many additional programs like the Medicare Advantage programs.
These programs can help provide coverage in areas that traditional Medicare does not cover or does not cover entirely.
In these programs, additional vision benefits can be purchased which may cover a routine eye exam and can cover glasses yearly instead of only following cataract surgery.
How to Determine Whether Medicare Will Cover Your Exam
The best way to determine whether Medicare will cover your exam or glasses is to contact your insurance representative directly.
By contacting them before your eye visit, you will know what coverage you have and will not be surprised by any potential charges at your visits.