Medicare does not cover routine eye exams, which are sometimes referred to as “eye refractions,” that are obtained for getting eyeglasses or contact lenses. However, Part B of Medicare will cover certain types of preventive and diagnostic eye exams.
The type of eye vision related exams that Medicare Part B covers may include the following:
Yearly Eye Exam
A yearly eye exam may be covered for diabetic retinopathy, provided that it is performed by a doctor who is legally allowed to do the test in the Medicare enrollee’s state. All individuals who have both Medicare Part B and who have diabetes are covered for this exam.
The cost for this exam will include 20% of the Medicare approved amount for the doctor’s service, as well as the Medicare Part B deductible. In addition, if the exam is performed in a hospital outpatient setting, there may also be a co-payment.
Medicare Part B may also cover a glaucoma test once every 12 months for those who are considered to be at a high risk for glaucoma. This particular screening must be done or supervised by an eye doctor who is legally allowed to do the exam in the Medicare enrollee’s state.
All individuals who are at high risk for glaucoma and who have Part B of Medicare are covered for this exam. To be considered a high risk individual, you will typically have diabetes, and you will also have the following characteristics:
The costs to the Medicare enrollee for this exam will include 20% of the Medicare approved amount, as well as the Part B deductible. Should the exam be performed in a hospital outpatient setting, there may also be a co-payment charged.
Part B of Medicare may also cover various diagnostic testing and treatment of diseases and conditions of the eye. These include treatment with certain drugs that are injected. Some Part B enrollees who have age-related macular degeneration are covered.
The costs for these tests to the Medicare enrollee will be 20% of the Medicare approved amount for the drug and the doctor’s services, as well as the Medicare Part B annual deductible. Should the examination take place in a hospital outpatient setting, the individual may also be responsible for paying a co-payment amount.
In order to determine how much a certain vision related test, item, or service may cost, a Medicare enrollee can discuss the situation with his or her doctor or other health care provider. The actual amount of the exam can depend on a number of factors, such as other insurance that you may have, how much the doctor charges, whether or not the doctor accepts Medicare assignment, the type of facility the test will be performed in, and the location where you will be getting your test, item, and / or service.
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