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Eye care can include many different aspects – eye exams and surgery, for example. Here’s a quick rundown of Medicare coverage of eye care.
Eye care: Routine eye exams
When it comes to routine eye exams, Medicare Part A and Part B (Original Medicare) typically doesn’t cover them. But Medicare Part B may cover eye exams that specifically screen for certain conditions, such as glaucoma or macular degeneration.
Medicare Part B (medical insurance) generally covers eye exams when your doctor accepts Medicare assignment and orders these screenings for you:
- Glaucoma – if you’re considered at high risk for this eye disease, Part B may cover an eye exam every 12 months. The health-care provider who performs or supervises the screening must be legally allowed to do so in your state.
- Macular degeneration – if you have age-related macular degeneration, Medicare Part B may cover screenings and treatment with an injected medication.
- Diabetic retinopathy – if you have diabetes, Medicare Part B may cover an annual eye exam to screen for diabetic retinopathy. The health-care provider who performs the screening must be legally allowed to do so in your state.
Eye care: Your Medicare costs
For the services described above, you’ll generally pay a 20% coinsurance amount under Medicare Part B. If you have the screening or treatment in a hospital outpatient setting, you usually pay a copayment. The Part B deductible typically applies in each of the cases listed above.
Eye care: Surgeries
Medicare may cover certain medically necessary eye surgeries, such as cataract surgery. Coverage details are different depending on whether you get the surgery as a hospital inpatient or as an outpatient. Generally Medicare Part A may cover inpatient services, while Part B may cover outpatient services. Deductible, coinsurance, and/or copayment amounts usually apply.
Eye care: Artificial eyes
Medicare Part B may cover artificial eyes if your doctor orders them for you. A 20% coinsurance and deductible generally apply.
Eye care under Medicare Advantage
If you get your Medicare benefits through a Medicare plan, coverage for Part B (and Part A) services is the same as through Original Medicare (except hospice services, which only Part A covers). The Medicare Advantage plan’s deductible, copayments, and/or coinsurance usually apply.
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