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What Senior Vision Care Services Are Covered Under Medicare?

May 1, 2014

Looking into what Medicare services seniors can expect through Medicare.

For seniors who suffer from common age-related vision problems such as cataracts or glaucoma, Medicare can be extremely helpful. For example, in many cases, it can help cover the many different tests and doctors appointments that are involved in the diagnosis and treatment of these vision diseases. However, it is not a blanket service that covers any and all vision ailments and appointments. In fact, Medicare can often be overly technical and specific about what senior vision care services are and are not covered.

To help Medicare users understand what kind of coverage they can expect when they go to the eye doctor, here is a breakdown and a closer look at the type of vision services that seniors can expect when they have basic Medicare coverage.


Are Eye Exams Covered?

Unless you have diabetes or are at a high risk for developing glaucoma, you will most likely not be entitled to yearly medical examinations through Medicare. People who are considered “high risk” include those who have a family history of glaucoma, people who are at a high risk for diabetes, and older Hispanics and African-Americans. In all other cases, Medicare does not cover routine eye exams.

Medicare also will not cover exams that test for eyeglasses or contact lenses. The only exception to this is if you are someone who has had a conventional intraocular lens that was inserted during cataract surgery. If this is the case, Medicare may help to pay for contact lenses or eyeglasses following the operation.

Is Eye Surgery Covered?

Luckily, a large number of eye surgeries, including cataract surgery, are covered by Medicare. This includes cataract surgery where cataracts are removed and a standard intraocular lens is inserted to replace your own. However, Medicare will not cover the cost of specialized lenses that are chosen for these procedures, such as a lens that restores your full range of vision and reduces your need for corrective lenses post-surgery. Medicare also does not cover the cost of the Fento Second Laser used to reduce astigmatism during HD Cataract Surgery.  It will simply cover the basic cost of the procedure, and you will be responsible for any premium costs not included in basic cataract surgery.

The only eye surgeries that are not typically covered by Medicare include cosmetic eye surgeries that are not medically necessary, such as eyelid surgery, or refractive surgery. However, there are a number of ways that you can fund these type of procedures outside of Medicare—check out our blog post on crowd-funding your vision surgery, for example.

However, even those Medicare will cover some of the costs associated with the procedures and exams we mentioned above, you may find that you still have a number of out-of-pocket costs in the end. Therefore, it is important to make an appointment with your eye doctor to determine what aspects of your vision surgery will be covered through Medicare, and to talk about what other options you have if Medicare will not cover your procedure. For instance, there are a number of alternatives to Medicare, including Federal Spending Account Dollars and OCLI’s own VisionHarvest service. For more information about your options, be sure to contact OCLI today.

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