Medicare Vision Coverage

medicare covered vision treatment plansLoss of vision among the elderly is a growing Medicare health coverage challenge as baby-boomers age and move closer to retirement.  The most common causes of vision loss among the elderly are macular degeneration, glaucoma, cataract and diabetic retinopathy. One in three elderly persons has some form of vision-reducing eye disease by the age of 65.

  • Eyeglasses or Contact Lenses

Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery that implants an intraocular lens, with Medicare Part B  you pay 20% of the Medicare-approved amount for one pair of eyeglasses or one set of contact lenses after each cataract surgery with an intraocular lens.

You pay an additional cost for frame upgrades (get those Guccis!), and insurance helps pay for corrective lenses (one pair of eyeglasses or one set of contact lenses). 

  • Glaucoma Test

Medicare Part B (Medical Insurance) covers a glaucoma test once every 12 months for people at high risk for glaucoma. The screening must be done or supervised by an eye doctor who’s legally allowed to do this test in your state. It also applies if you’re at high risk if you have diabetes, a family history of glaucoma, are African American and 50 or older, or are Hispanic American and 65 or older. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a hospital outpatient setting, you also pay a copayment.

  • Diabetic Retinopathy

Medicare Part B (Medical Insurance) covers a yearly eye exam for diabetic retinopathy by an eye doctor who’s legally allowed to do the test in your state. So Diabetic patients are eligible. You pay 20% of the Medicare-approved amount for the doctor’s services, and the Part B deductible applies. In a hospital outpatient setting, you pay a copayment.

  • Ocular Degeneration

Medicare Part B (Medical Insurance) covers certain diagnostic tests and treatment of diseases and conditions of the eye like lucentis, avastin, aflibercept, pegaptanib, and ocular photodynamic therapy with verteporfin (Visudyne®). Some people with Medicare who have age-related macular degeneration (AMD) are covered. You pay 20% of the Medicare-approved amount for the drug and the doctor’s services, and the Part B deductible applies. In a hospital outpatient setting, you pay a copayment.

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