Medicare Vision Benefits

Medicare offers health coverage to Americans age 65 and older, those with certain disabilities and anyone with permanent kidney failure for a low monthly premium. The Medicare vision benefits fall under Part B of the original Medicare plan and do not include rules that may vary for alternate Medicare plans.

Eye Exams

• Medicare vision benefits do not cover routine eye exams, also called eye refractions, for eye glasses or contact lenses. However, Medicare does cover preventative and diagnostic eye exams for certain medical conditions under Part B. For those with diabetes, Medicare will cover 80 percent of the Medicare-approved amount for a qualified eye doctor to do a yearly eye exam to screen for diabetic retinopathy. Medicare also allows anyone at high risk for glaucoma to receive a glaucoma test once every 12 months at 80 percent coverage of the Medicare-approved amount. Medicare vision benefits cover 80 percent of the cost of diagnosing and treating diseases of the eye for patients with age-related macular degeneration. For all of these services, a co-payment is required if the exam occurs in a hospital outpatient setting.

Eyeglasses

• Medicare vision benefits do not cover any costs for eye glasses or contact lenses under normal conditions, except in the case of cataract surgery with an implanted intraocular lens. Following such a surgery, Part B of your Medicare plan will pay 80 percent of the Medicare-approved amount toward a pair of eye glasses or contact lenses. You must pay any additional cost for upgraded frames. This Medicare vision benefit kicks in after each cataract surgery with an implanted intraocular lens, so you can take advantage of it multiple times if you need more than one surgery.

Definitions

• Medicare-approved amount: the figure that Medicare determines to be a reasonable fee for a service covered under Part B of Original Medicare. This amount includes what Medicare pays along with any deductibles, coinsurance or co-payments paid by you. The Medicare-approved amount may be less than the actual charge you receive from your medical provider, in which case you are responsible for the difference.

  Co-payment: the amount you must pay as your contribution toward your medical costs. Co-payments generally have a set dollar amount instead of a percentage per each type of service. For example, a co-payment might be $25 for a medical office visit but $10 for a prescription.

  Original Medicare: the standard, fee-for-service Medicare plan which has a Part A and a Part B. Part A is hospital insurance and automatically kicks in once you turn 65 at no additional cost to you. Technically, you already pay for this coverage with your Medicare taxes while you work and earn taxable wages. Part B is medical insurance and does have a premium of $96.40 or $110.50 per month as of 2010, depending on your household income and martial status.