Medicare provides specific coverage for eye-related medical services, primarily focusing on treatment and prevention of serious eye conditions rather than routine vision care. Here are the key eye-related medical services covered by Medicare:

1. Cataract Surgery

Medicare Part B covers cataract surgery that implants an intraocular lens. After the surgery, Medicare will also cover one pair of prescription eyeglasses, or one set of contact lenses provided by a supplier enrolled in Medicare.

2. Eye Exams for Diabetics

For individuals with diabetes, Medicare covers an annual eye exam for diabetic retinopathy by an eye doctor who is legally allowed to do the test in your state. This is crucial for early detection and treatment of eye conditions associated with diabetes.

3. Glaucoma Screening

Medicare covers glaucoma tests once every 12 months for people at high risk for developing glaucoma. This includes individuals with diabetes, those with a family history of glaucoma, African Americans aged 50 and older, and Hispanic Americans aged 65 and older.

4. Macular Degeneration

Treatment for certain cases of age-related macular degeneration (AMD) is covered under Medicare Part B. This includes diagnostic tests and treatment procedures, including certain injectable drugs, for patients with AMD.

Not Covered by Medicare:

1. Routine Eye Exams

Medicare does not cover eye exams (refractions) for prescribing glasses or contact lenses.

2. Eyeglasses and Contact Lenses

Apart from the exception following cataract surgery, Medicare does not cover eyeglasses or contact lenses.

3. Cosmetic Surgery

Any cosmetic surgery to improve the appearance of the eyes is not covered.

For broader vision coverage, individuals may consider separate vision insurance plans, as these may offer additional vision benefits beyond what Original Medicare provides. Many Medicare Advantage plans offer additional coverage for vision services, but the benefits vary from plan to plan. Some Medicare Supplement carriers also offer vision care which can be sold as part of the plan’s benefits or as a separate rider.

Do you have questions about Medicare? Our licensed agents are waiting to help you! Simply give us a call today at 855-611-4856. At AMAC, we make Medicare make sense!