Medicare and Eye Exams

2014 Medicare and Medigap Updates

Medicare and Eye Exams

Many new Medicare policy owners get an unpleasant surprise when it is time for them to get an eye checkup. In general, Medicare does not cover routine eye care although there can be exempting circumstances that can compel Medicare to provide this service.

In this post, we will talk about Medicare and eye exams; specifically the cases when Medicare covers routine eye care. Policy owners need to know this information so as to claim Medicare benefits if their circumstances warrant such a claim.

Medicare will only cover for eye-related services when any of the following conditions are met:

• Surgery because of an underlying eye condition - Cataracts are prevalent among many Medicare policy owners as it is closely related to age. Medicare policy owners cannot rely on Medicare to pay for their annual eye examination to watch out for cataract but if and when it is present, Medicare will shoulder the bill for surgery for cataract removal as well as replacement of the eye’s lenses with a man-made alternative.

• All forms of eyeglasses and contact lenses are beyond the scope of Medicare except if it is a requirement post cataract surgery. Medicare will pay for a pair of normal, un-tinted contact lenses or eyeglasses as recommended by the eye surgeon.

• Diagnostic tests for suspected serious eye conditions like glaucoma. Oftentimes, during annual physical examinations, doctors will raise a red flag over a potential condition of the eye that might need further examination. Armed with this recommendation, Medicare can foot the bill for your diagnostic eye exam even when there is no actual condition discovered during the checkup.

• In the case of diabetes patients with a known risk for eye problems, Medicare and eye exams can go hand-in-hand. Medicare will pay for your annual medical eye checkup to check for any developing condition because of the diabetes.

• Patients at risk of developing glaucoma can also petition Medicare to cover their eye exams. Annual medical exams for determining the existence of glaucoma can be given to patients who have glaucoma in their family history, have diabetes, are of African American descent and above 50 years of age, or of Hispanic descent and above 65 years old.

It is these varying conditions that oftentimes confuse patients about the coverage of Medicare and eye exams. When in doubt, it is best to check with your doctor if Medicare would be liable for paying for a specific eye procedure due to underlying conditions that can be invoked to support your claim.

So whenever you feel that you are in need of eye exams, talk to your doctor immediately so you can get the proper recommendation. Hopefully, Medicare and eye exams will go together in your specific case. The few hundred dollars that you can save out of this process can be instrumental in helping you tide over a difficult financial situation without compromising your health or your ability to care for yourself at a time when money is an issue.