Social Security & Medicare Questions: August 2013

Social Security & Medicare Questions: August 2013

Q: Does Medicare cover eye care? I'm diabetic and require eye exams frequently.

A: Medicare generally will not pay for routine eye exams and glasses, but will pay for some services if you need treatment for eye diseases like diabetes. Medicare Part B will pay for a diabetic retinopathy exam once every 12 months if you have diabetes or are at high risk of glaucoma. Those at high risk are people who:

  • have diabetes;
  • have a family history of glaucoma;
  • are African American and age 50 or older; or
  • are Hispanic and age 65 or older.

You must use an eye doctor who's legally allowed to do the test in your state. You will pay 20 percent of the Medicare-approved amount for the doctor's services and the Part B deductible applies.

Visits to get a prescription for glasses aren't covered by Medicare, so make sure the doctor bills you separately for that portion of the visit or Medicare may not cover your exam.

The good news is that Medicare will pay for surgical procedures to repair the function of the eye due to diabetes, cataracts or glaucoma. For example, Medicare will cover surgery to remove a cataract and insert a man-made intraocular lens to replace your own. There are restrictions, though. Medicare considers specialized lenses like those that correct astigmatism or "presbyopia," which makes it difficult to focus, to be an elective procedure, similar to laser eye surgery, and doesn't cover it. Doctors are responsible for informing Medicare patients that they will be responsible for the additional out-of-pocket costs, so read through that pile of papers you are given at your next visit to your eye doctor.

While original Medicare and Medigap supplements don't cover routine exams or eye glasses, many Medicare Advantage or retiree benefit plans through former employment typically do. Medicare Advantage plans often use a network of participating hospitals and providers that can be limited to certain areas. If you have a serious vision problem, or if you travel a lot, you will need to make sure that the specialists and facilities that you think you would use are in the plan.

For more information about your coverage, contact your Medigap supplement or Medicare Advantage plan. Online visit