Medicare benefits do not cover routine eye examinations.
Medicare is a federal health insurance program that provides health care benefits and coverage for nearly 40 million Americans. Individuals over 65 years of age, those younger than 65 with disabilities, and people of all ages with end-stage renal disease are eligible for Medicare. Free hospital, nursing and hospice care are available for eligible individuals. Medicare benefits also cover some optical procedures, although claimants may have to pay a percentage of the costs.
Cataract Surgery
Medicare benefits cover cataract surgery, as well as contact lenses, eye glasses or intraocular lenses (lenses embedded into the eye during cataract surgery) following this surgery. These benefits also cover the glasses or lenses of the claimant if she has the surgery before Medicare benefits even begin. If a claimant only has cataract surgery on one eye, Medicare will cover a pair of glasses or lenses for both eyes. Medicare will cover one pair of glasses with standard frames, but only if the supplier is enrolled in the Medicare program.
Glaucoma
Medicare covers glaucoma screening for individuals who are at high risk for this eye disease, such as African-Americans age 50 and older, those who suffer from diabetes and those who have a family history of glaucoma. Medicare will pay 80 percent of the cost of this annual screening, as long as the procedure is performed by a licensed eye doctor in the claimant's state.
Age-Related Macular Degeneration
Age-related macular degeneration affects older adults and results in a loss of central vision due to damage of the eye's retina. A successful treatment for age-related macular degeneration is ocular photodynamic therapy with verteporfin. A photosensitive drug, verteporfin, is injected into the eye and adheres to the damaged tissue. This damaged tissue is then irradiated by a laser. Medicare covers 80 percent of the costs involved in this treatment.
Eye Prostheses
Medicare covers the full cost of an eye prosthesis if the claimant has either lost an eye or has experienced shrinkage of an eye due to trauma, a surgical removal or a birth defect.
Routine Eye Examinations
Individuals seeking routine eye examinations must pay 100 percent of this cost. Medicare does not cover these examinations, nor the cost of eye glasses or contact lenses that may be prescribed from these examinations.
