Last Updated : 10/03/20194 min read

Routine eye and vision exams can be an important part of your overall health care. Original Medicare (Part A and Part B) usually doesn’t cover eye exams except in certain cases as described below. This summary of your Medicare benefits will help you understand your coverage.

Kaiser Eye Exam Copay

Find affordable Medicare plans in your area

When might Medicare cover eye exams?

While Original Medicare doesn’t generally cover routine eye care, there are a few instances when your Part B coverage may help offset your eye exam costs:

• If you are considered to be at high risk for glaucoma (if you have diabetes, a family history of glaucoma, or are African American and over age 50, for example), Part B may cover 80% of allowable costs if your doctor believes the test is medically necessary.
• If you have diabetes, Part B may cover 80% of your eye exam cost to check for diabetic retinopathy.
• Certain people with age-related macular degeneration may qualify for Part B coverage of eye exams and treatment, including injectable medications, for the disease.
• If your eye gets injured, Original Medicare may cover medically necessary diagnostic eye exams and treatment.

.Comparison is based on national averages for comprehensive eye exams and most commonly purchased brands. This chart represents an average savings for VSP members. Your actual savings will depend on the plan available to you, your copays, contribution level, and whether your contribution is deducted from your paycheck pre-tax. Comprehensive Eye Exam: Covered in full after applicable $10 copay FRAME BENEFITS. Eyeglass Frames: $50 Wholesale Allowance EYEGLASS LENS BENEFITS (CR-39 standard plastic or glass). Bifocal Lens: Covered in full after applicable $20 copay Blended Bifocal Lens: Covered in full after applicable $20 copay Digital/Elite Progressive: Partially-Covered after applicable $20 copay. For some, the vision plan covers the full cost of a regular annual eye exam. Other plans charge a copay of $5 to $35. Some clinics have a separate charge for retraction, a test that determines the patient's prescription. This varies by clinic, ranging from $15 to $40 at the Main Line Eye Specialists. . Routine eye exam: $0 copay per visit (up to 1 every calendar year). Routine eyewear: up to $200 allowance every calendar year Mental Health Services. Individual and group therapy: $35 copay per visit. Services with an. (asterisk) may require prior authorization from your doctor.

You must get care from a provider who accepts Medicare assignment in order to be covered. You’ll generally also pay 20% of allowable charges plus any applicable Part B deductible.

Does Medicare cover routine eye exam costs?

Except in the circumstances noted above, there is generally no Part B coverage for routine eye exams and vision checks. If you wear prescription eyewear or contact lenses, these costs are also not included in your Part B benefits, except in certain medical situations. For example, if you have cataracts and undergo surgery for treatment, Part B may cover one pair of prescription eyeglasses or contact lenses after the procedure. Your Part B coinsurance and deductible applies.

Are there other options to get Medicare coverage for eye exam costs?

Eyemed Eye Exam Copay

You may be able to enroll in a Medicare Advantage plan that offers coverage for routine eye exam costs and even prescription eyewear. The Medicare Advantage program is an alternative way to get your Original Medicare benefits. These plans must provide the same coverage as Part A and Part B (except for hospice care, which is still covered under Part A).

Many Medicare Advantage plans include coverage for prescription drugs, as well as other benefits to help you manage your health-care costs, such as: Argosy research scsi & raid devices driver download for windows 10.

• Benefits for routine vision care, including an annual eye exam and prescription eyewear
• Coverage for routine hearing care
• Optional dental care coverage for routine exams, cleanings, and even restorations and dentures
• Benefits for wellness programs and discounted gym memberships

Not all Medicare Advantage plans have all these optional benefits and coverage, and not all plans may be available in all areas. You must continue to pay your Part B premium, plus any additional premium required by your plan, and premiums may vary depending on the plan you choose and where you live. You will also be responsible for any copayments, coinsurance amounts, or deductibles required by your plan.

Eyemed Eye Exam Copay

Some Medicare Advantage plans require you to get your care from providers in the plan’s network, or offer you significant savings if you choose the plan’s preferred providers. If you enroll in a Medicare Advantage plan, you still have all the same rights and protections you get with Original Medicare, and you can still return to Original Medicare during the Medicare Open Enrollment period between January 1 and March 31 of every year. You can also switch from one Medicare Advantage plan to another during this period.

Unitedhealthcare Eye Exam Copay

Request an email or schedule a telephone call by using one of the links at the bottom of the page. To see a list of plans in your area you may qualify for, click the “Compare Plans” button on this page.