Medicare does not typically cover routine eye exams for glasses or contact lenses. However, some Medicare Advantage plans offer additional vision coverage.
Medicare Part B covers annual eye exams for diabetic retinopathy, which can lead to vision loss. In addition, Medicare can help with the cost of glaucoma screenings if you are at high risk.
Diabetic retinopathy causes changes in vision and is usually the result of high blood sugar damaging retinal blood vessels. Over time, damaged blood vessels can bleed into the vitreous, causing dark floaters in your field of vision. If not treated, bleeds and scar tissue can cause permanent vision loss.
To detect these problems, doctors must perform a medical eye exam. This is a special type of Medicare eye exam called a dilated retinal exam, and it involves eye drops that dilate your pupils so the doctor can see your entire retina and the optic nerve. Medicare Part B generally covers a dilated retinal exam once each year for people with diabetes.
Although evidence supports the general recommendation that all adults with diabetes should have a yearly eye exam, barriers such as poor care coordination and referral, low health literacy, and lack of perceived need limit adherence to this preventive service. Addressing these barriers might help prevent irreversible vision loss among people with diabetes.
Glaucoma is a group of conditions that damage the optic nerves, which relay visual information from the eye to the brain. It is usually caused by too much pressure in the eye, but the exact cause varies between the various types of glaucoma.
Symptoms of glaucoma may not show up until vision loss is quite advanced. That’s one of the reasons why regular screenings are so important. During an exam, your doctor can measure your intraocular pressure (IOP), which is a key factor in diagnosing the condition.
Medicare Part B typically covers a glaucoma screening once per year. However, you will need to pay your Medicare Part B deductible and 20% of the Medicare-approved amount for the test. You can lower your out-of-pocket costs by choosing a doctor that accepts assignment, which means they agree to accept the Medicare-approved amount as payment in full. Medicare Advantage plans are required to cover the same medically necessary services as Original Medicare, including glaucoma screenings.
Age-related macular degeneration (AMD) is the leading cause of vision loss for Americans over 60. It causes blurred central vision, which makes it hard to read or drive. It also causes distorted vision, which can be recognized by straight lines that appear wavy or blank. There are two forms of the disease, dry and wet macular degeneration. Dry AMD usually progresses slowly, but wet AMD can progress faster and lead to blindness.
Your doctor may perform a test called fluorescein angiography or optical coherence tomography (OCT) to check for signs of AMD. In angiography, your doctor injects dye into your arm and takes photos of the retina as the dye flows through blood vessels in your eye. The test can reveal leaking fluid or new blood vessels beneath your retina. These tests can help your doctor diagnose and treat macular degeneration before it gets worse.
Cataracts are the leading cause of blindness worldwide. They develop when proteins in the clear lens at the front of your eye break down and clump together. This cloudy buildup affects your vision, especially in bright light. Symptoms include blurry or fuzzy vision.
While cataracts typically occur in people over age 65, they can form earlier in life as a result of certain health conditions or medications, like steroids or some types of eczema. Some people are more at risk for developing cataracts, including those with diabetes and high blood pressure.
Medicare Part B helps pay for a yearly eye exam to check for glaucoma and macular degeneration, as well as cataract surgery if you need it. Some Medicare Advantage plans may also cover eye care and treatment. However, premiums, deductibles and copayments vary by plan. You can find out more about the different Medicare plans by visiting our Compare Medicare Plans page. Also, consider getting a Medigap policy to help with costs not covered by Medicare.