Vison Benefits and Medicare?

[eliuri]

Hello:

I keep reading that Medicare does not cover eye care/vision.

But elsewhere i read that although it does not cover are routine eye exams and glasses, it does cover tests for possible medical/visual issues such as cataracts/glaucoma..etc..and apparently it covers the treatment for such visual diseases.

Here's an example of how this distinction is phrased:

at:
vision.about.com (Section on: Medicare Vision Benefits)

I do want to make you aware that while Medicare does cover medically necessary eye care and office visits,
it does not pay for routine eye exams.

Would someone be able to better clarify this distinction and guide me to where I can learn about this further?

Thanks in advance

 

[mattspits]

Dear eliuri,

I'm including a link that should answer your question. I hope this helps you with your situation. Please click on Medicare Vision Services to see what CMS has to say about the coverage. The article is comprehensive and covers most scenarios. If you found this helpful you can check out my Medicare Plans blog by clicking the blog link at the bottom of this post.

Sincerely,

Matt

Hello:

I keep reading that Medicare does not cover eye care/vision.

But elsewhere i read that although it does not cover are routine eye exams and glasses, it does cover tests for possible medical/visual issues such as cataracts/glaucoma..etc..and apparently it covers the treatment for such visual diseases.

Here's an example of how this distinction is phrased:

at:
vision.about.com (Section on: Medicare Vision Benefits)

I do want to make you aware that while Medicare does cover medically necessary eye care and office visits,
it does not pay for routine eye exams.

Would someone be able to better clarify this distinction and guide me to where I can learn about this further?

Thanks in advance

 

[eliuri]

Thank you for that link Matt, as well as the link to the blog.

I did call Medicare this afternoon, and they did say that in terms of visual care, they can say what's not covered, and I could assume that other services, if medically needed are covered. Not covered are routine eye exams, eyeglasses and contacts. Pretty much all else is covered if a doctor deems it needed. I hope I understood her correctly. I forgot to ask who covers the eye doctor visit in the first place.

Your link does go into much more details, but most of it is a bit too technical for me. I'll re-read it a few times perhaps.

I'm wondering if under Medicare, one can simply have a visit at a clinic such as the New York Eye and Ear Infirmary, and pay for the eye exam and glasses out of pocket? Would such an initial clinic visit to assess difficulty with reading be covered? Would Medicare separate the clinic visit from the actual eye exam?

Hope this question makes sense.

Dear eliuri,

I'm including a link that should answer your question. I hope this helps you with your situation. Please click on Medicare Vision Services to see what CMS has to say about the coverage. The article is comprehensive and covers most scenarios. If you found this helpful you can check out my Medicare Plans blog by clicking the blog link at the bottom of this post.

Sincerely,

Matt

Hello:

I keep reading that Medicare does not cover eye care/vision.

But elsewhere i read that although it does not cover are routine eye exams and glasses, it does cover tests for possible medical/visual issues such as cataracts/glaucoma..etc..and apparently it covers the treatment for such visual diseases.

Here's an example of how this distinction is phrased:

at:
vision.about.com (Section on: Medicare Vision Benefits)

I do want to make you aware that while Medicare does cover medically necessary eye care and office visits,
it does not pay for routine eye exams.

Would someone be able to better clarify this distinction and guide me to where I can learn about this further?

Thanks in advance

 

[mattspits]

Yes, i know, anything put out by CMS can be difficult at best to decipher! That sounds like it would be a routine visit. It is all in how it is coded on the billing end. If it is an exam to diagnose or treat conditions/disease of the eye, it is covered. If coded as a routine eye exam, it is not. I hope that helps.