The U.S. is one of the countries that does not offer free healthcare or free education, but it makes up for this by offering great healthcare programs to help people pay for their procedures.
In this article we will be discussing vision coverage for senior citizens, answering the question “does medicare cover vision?”, and the questions “what is an ophthalmologist?”, and “does medicare pay for ophthalmologist visits?”. But first, let us start off this article with some of the benefits you receive once you get Medicare.
The Beginning Of Medicare And Its Purpose
The Medicare program was created in 1965 because people over the age of sixty-five were finding it extremely difficult to find affordable health insurance coverage from private providers. Vision coverage for senior citizens became a concern because as people age their vision deteriorates and so the most basic and most important benefit that all Medicare programs gave its customers was coverage for emergency and urgent care. If you have a Medicare Advantage program, it may pay for extra services and benefits which include wellness programs, hearing, dental, vision, and other health-related services. Another advantage of having Medicare is that the coverage for an advantage program is a pay-as-you-go type of insurance and you can opt-out at any time. Because Medicare is considered an all-in-one health insurance program, you will and can only carry one card to pay for three separate services (medical, hospital, and prescriptions) as opposed to carrying three different ones and having separate transactions.
Vision For Senior Citizens
In this section we will begin discussing vision coverage for senior citizens and what it entails. The center for disease control estimates that problems with eyesight radically increase as people age and it doesn’t matter what their race or ethnicity is. The problem increases even more radically as people begin to age past seventy-five. For this reason, it is a sad thing to know that the answer to the question, “does medicare cover vision,” is a big NO, with some exceptions. Generally, Medicare will not cover any regular eye exams or prescriptions to glasses or contacts. It will, however, cover some items after a certain procedure is done to one or both of the eyes and the items such as corrective eyeglasses will be needed. Also, it can cover some of the items listed on the bullet points below:
Preventive and Diagnostic Exams (Covered by Medicare Part B)
- Diabetic retinopathy exam: Your Medicare program will cover this preventive exam if you have diabetes and will allow you to do it once per year. This diabetic retinopathy disease is caused by blood sugar affecting the vessels of blood in the retina. Typically you would have to pay 20% of the amount for this exam.
- Glaucoma test: Glaucoma damages the optic nerve and Medicare will cover one glaucoma test for every twelve months, just like the previous exam. You are at risk of developing glaucoma disease if you currently have diabetes or if your family has a history of it. If you’re fifty or older and an African American or sixty-five or older and Hispanic, you are also at risk of this disease.
- Age-related Macular Degeneration: Your Medicare provider may be able to cover treatment if you have this degeneration problem so make sure to ask. Macular generation should be treated immediately since it causes your central vision to become impaired and damages the part of the eye called the macula.
- Cataract Surgery: Medicare does not cover this procedure, but it will cover glasses or contact lenses to correct your vision in the case when you do this cataract surgery and are implanted with an intraocular lens.
- Routine vision care: The only way that Medicare will pay for your routine vision care is if you enroll in what is called a Medicare Advantage Plan. In order to know if you qualify or if these are available in the area where you live, contact the Medicare website or an office near you.
Visits To The Ophthalmologist
Does Medicare pay for ophthalmologist visits? An ophthalmologist is a professional who specializes in the treatment of diseases and disorders of the eye. Because an ophthalmologist’s job is both to diagnose and treat certain disorders of the eye, his or her services may or may not be covered by your Medicare program. It’s always best to contact both the provider and the ophthalmologist because even though Medicare may cover it, your ophthalmologist may not even accept payment in this way so it’s always good to ask.
Glasses or Contacts
As a general rule of thumb you should know that Medicare will not be paying for glasses or contacts, but just like anything else, there are some exceptions. These exceptions are if you’ve had cataract surgery and need corrective vision lenses, as we discussed earlier. Another exception is for prescriptions on the same post-cataract related treatment which do include standard frames, glasses and contacts even if the surgery happened before you enrolled in medicare, and the ability to have lenses on both eyes even if you only did the surgery on one of them. The most stringent regulation to these exceptions are that the prescription is filed by the ophthalmologist with the supplier of the glasses or contacts and the supplier must also be enrolled in medicare. Medicare will not pay for the claim if the supplier does not have the required supplier number which is given to a supplier after meeting some very strict standards.
Other Medicare Options
Because not all medicare plans cover vision or regular routine eye care, it is important to find out which type of plan you have. It is also important to do research on what your state offers because some medicare programs that claim to be the same may offer different coverage in different states and you may not be aware of what they are. Below, we have listed the four types of medicare available to you and what they each offer.
The Four Parts of Medicare
- Medicare Part A: In its most basic terms, part A is hospital insurance. Medicare Part A will only cover your vision insurance if the condition is what’s commonly referred to as a “medical problem” or an emergency in which the patient must be seen immediately.
- Medicare Part B: In its most basic terms, part B is medical insurance. Medicare Part B will cover some vision care but will absolutely not cover routine exams as we’ve been saying throughout this article. It will, however, cover glasses and contact lenses after a cataract surgery. It will also cover your yearly preventive exams which we listed in the “Preventive and Diagnostic Exams (Covered by Medicare Part B)” section.
- Medicare Part C: In its most basic terms, part C can be considered “Medicare Advantage” and was created as the alternative to the original benefits offered by medicare. Though they are approved by medicare, these plans are often provided by private insurers. Because these are given by third party insurers, it may be your best bet to receiving routine eye care, free visits to the ophthalmologist, and even free contacts and glasses.
- Medicare Part D: In its most basic terms, part D can be considered as prescription drug insurance. Because it is separate from the other parts, you will have to sign up for it individually in addition to your part A or part B coverage. This is the same as part C in the sense that they are administered by third parties approved by medicare. The prescription drugs available to you will be anything from eye drops or medications needed to help your current eye situation as prescribed by the ophthalmologist or doctor.
Final Thoughts for Medicare and Vision
Keep in mind that no matter what plan you choose, you are more than likely going to benefit best from part B and so you need to understand the costs that come with it. You still have to pay premiums and deductibles and in 2017 these came out to be $134 per month for the standard premium, and $183 for the yearly deductible. Once the yearly deductible is reached you will then need to pay the 20% we mentioned earlier for almost every service and treatment you incur for vision related processes. Paying for glasses or contacts is most likely out of the picture in most cases, and I think we thoroughly answered the question, “does medicare cover vision.”? This article focused on vision coverage for senior citizens and so we did not discuss children or low-income families. We also answered the question, “what is an opthamologist?”, and gave a solid NO as an answer to the follow-up question, “does medicare pay for opthamologist visits?”. Even though paying for glasses or contacts is not the main concern of medicare you can get them in certain occasions.