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Insuring Your Eye Health (continued)

(Please see previous blog for more information)

Vision Services for Children: The Affordable Care Act and Your Child’s Eyes

Recent changes in federal law may impact the kinds of vision and eye health services your child has access to through health insurance. As of 2014, all health insurance plans have to include coverage for children’s vision. In most states, this means that new insurance plans will cover one comprehensive eye exam and one pair of glasses each year.

Vision Services of Older Adults – Medicare and Your Eyes

Medicare beneficiaries, especially those at risk for or diagnosed with a variety of diseases, are entitled to a number of vision-related services. It is especially important for people with diabetes, a family history of glaucoma, or those who have suffered an eye disease or injury to be aware of and utilize these benefits. Below are details about medical benefits that may be available to you.

Routine Eye Exams

Medicare does not cover the cost of routine eye exams, with some exceptions. Medicare does help cover the exam if you have diabetes, or are at risk for glaucoma. Keep in mind that Medicare does not cover refractions for eyeglasses or contacts even as a part of some otherwise covered exam. Medicare does not cover eyeglasses or contact lenses, except immediately following cataract surgery. Medicare does cover an eye exam for medical reasons, such as in the case of injury or disease. Medicare Advantage plans, which are administered by private companies, often choose to offer vision coverage and Medicare beneficiaries also have to option to purchase supplemental vision coverage that may cover routine eye care or help to cover the cost of deductibles and other fees.

Glaucoma

Glaucoma is called “the sneak thief of sight” because often there are no warning signs, but there is treatment for glaucoma if detected early.  A leading cause of blindness, glaucoma affects close to 2.7 million Americans age 40 and older.  Medicare provides annual coverage for glaucoma screenings if you fall into one of the high risk groups below:

  • Individuals with a family history of glaucoma – family is blood parent or sibling
  • Individuals with diabetes – either controlled by diet, pill, or insulin
  • African Americans age 50 or older
  • Hispanic individuals age 65 or older

Medicare will cover 80% of the doctor’s exam fee.  You or your secondary insurance must pick up the deductible and the remaining 20% balance.  A minimum of 366 days is required between glaucoma screening visits.

Diabetes

If you have diabetes, you are at risk for developing diabetic retinopathy, glaucoma, and cataracts.  Diabetic eye disease can affect anyone with diabetes.  Often there are no symptoms, so it is important to see your eye doctor regularly for a comprehensive eye exam.  Medicare beneficiaries with diabetes qualify for the annual glaucoma screening benefit, as discussed above.  Because people with diabetes need to have an eye exam at least once a year, you should take full advantage of the benefit to receive an eye exam that can check both glaucoma and diabetic retinopathy.

Cataract Surgery

Cataracts affect millions of Americans and is the leading cause of blindness worldwide.  In the U.S., cataract surgery is the most common surgical procedure in those 65 and older.  Medicare beneficiaries have two choices for cataract surgery in addition to the cataract removal: receiving basic lens replacement (IOL), paid in full by Medicare up to $2000, or applying the credit to a lenses that can correct both near and farsightedness (multifocal IOLs).  Patients are then responsible for paying the difference.

Medicare also covers corrective eyeglasses or contacts following cataract surgery.  Medicare pays 80% of the Medicare-approved amount for one pair of eyeglasses or contacts after each cataract surgery.  The beneficiary pays any additional charges for upgraded frames or lenses and the applicable Part B deductible.

Age-related Macular Degeneration (AMD)

AMD diminishes central vision that currently affects the vision of more than 2 million Americans age 50 and older.  AMD is a progressive disease that, if left untreated, can result in severe vision loss and blindness.  Medicare covers the treatment for AMD, including Avastin, Eylea, Lucentis, pegaptanib, and ocular photodynamic therapy with verteporfin (Visudyne).  The beneficiary pays 20% of the Medicare-approved amount for the drug and the doctor’s services or a co-payment if the treatment if offered in a hospital outpatient setting.

Help with Medicare

If you need help, have questions, or need one-on-one counseling about Medicare related issues, you can contact the Medicare organization that covers Alabama by going to www.shiptalk.org for answers.  Or you can call our office, and we will try to assist you in determining the care you are eligible to receive.