Glasses, Contacts, and Eye Exams: Does Medicare Cover It?

In your 60s and beyond, eye conditions like cataracts, diabetic retinopathy, glaucoma, and age-related macular degeneration are extremely common, with some conditions occurring in more than half of seniors.

Once you turn 65, you’re probably relying on Medicare coverage to help with vision expenses. We turned to Dr. Bradley Grant, O.D. at Mid-State Eye in Central IL for some insight into how Medicare helps pay for things like glasses, contacts, eye exams, and common treatments.

Need Medicare or retirement planning help? The Sams/Hockaday team specializes in Medicare health insurance as well as retirement planning. Read more about what we do and schedule an appointment with the agent of your choice today!

Common Eye Conditions Over Age 65

About 65% of Mid-State Eye’s clientele is over the age of 65. In fact, Medicare is their largest payor. Dr. Grant says about half of the appointments he has are routine, while the other half are for eye conditions and diseases. 

“The most common issues we see are glaucoma, cataracts, and macular degeneration. Also, diabetes – we often do diabetes checks for the eyes,” he says.

Glaucoma

Glaucoma is an increase in the intraocular pressure of the eyes which causes damage to the optic nerve with no signs or symptoms in the early stages of the disease. If left untreated, it can lead to blindness.

Dr. Grant explains glaucoma is different from the other three common conditions and diseases because it’s typically asymptomatic. 

“You can usually tell if your vision is changing, but with glaucoma, it goes completely undetected without routine monitoring,” he explains.

More than three million Americans live with glaucoma, the vast majority of whom are 40 or older. The Glaucoma Research Foundation and the World Health Organization report that glaucoma is the second leading cause of blindness in the world, after cataracts. African Americans are particularly susceptible.

Other high-risk groups include people over 60, a family history, diabetics, and people who are severely nearsighted.

There’s no cure for glaucoma, but medications and surgery can help stop the damage from continuing. That’s why regular exams are so critical – early detection is the best way to stop glaucoma from severely impacting your vision.

Cataracts

Cataracts are the leading cause of irreversible blindness in our country. By age 75, about half of all Americans have cataracts (American Academy of Ophthalmology). 

A cataract is a clouding of the eye’s lens that leads to blurriness and even blindness. 

A cataract starts out small and initially has little or no effect on vision. As the cataract progresses, it becomes harder to read and perform other normal tasks. 

In the early stages, your doctor may recommend stronger eyeglasses and adjusting your lighting to reduce glare. When cataracts disrupt your daily life, your doctor may recommend cataract-removal surgery which is one of the most frequent and successful procedures done in the U.S.

Macular Degeneration

Macular degeneration is a chronic, progressive disease that gradually destroys sharp central vision due to a deterioration of the macula. The macula is a tiny spot in the central portion of your retina made of millions of light-sensing cells. 

Your macula is what allows you to see fine detail and colors. When these are affected, you may have trouble seeing faces clearly or reading books.

Because macular degeneration is so commonly associated with aging, it’s also known as age-related macular degeneration (AMD).

According to the American Academy of Ophthalmology, by age 80, one in 10 Americans has late AMD.

In most cases, you can’t reverse damage caused by AMD, but you can reduce your risk by doing a few things:

• Taking recommended supplements – see an eye doctor for advice
• Protecting your eyes from sunlight
• Eating a balanced diet
• Quitting smoking

Laser procedures can help treat some types of macular degeneration, and genetic testing is also available to identify which kind of macular degeneration you have.

Diabetic Eye Disease

Diabetic eye disease is a general term for a group of eye problems that can result from having type 1 or type 2 diabetes, including diabetic retinopathy, cataracts, and glaucoma.

Approximately 100 million U.S. adults live with diabetes or prediabetes (CDC), and about one in three people with diabetes over age 40 have signs of diabetic retinopathy (NIH).

When your blood glucose, or blood sugar, gets too high, it can damage blood vessels in the back of your eyes. This damage can begin during prediabetes, and you may notice symptoms like leaking fluid or swelling. Over time, weak blood vessels grow that can bleed into the middle of your eye, leading to scarring and high pressure in the eye.

Often there are no symptoms in the early stages of diabetic eye disease, so it’s important to have comprehensive eye exams. Early detection and treatment of diabetic eye disease will dramatically reduce your chances of sustaining permanent vision loss.

Medicare and Vision Coverage

“Most people are surprised to know they have better coverage than they think for medical eye exams,” says Dr. Grant.

Medicare covers almost all vision care – the only exceptions are materials, like glasses or contacts, and the portion of your eye exam that checks your glasses.

Dr. Grant explains that when someone comes in, they bill most of the exam to Medicare. The patient would only have a charge for the checking of the glasses, which isn’t covered by Medicare.

If the eye exam is for any kind of condition, such as cataracts, Medicare covers it.

“As long as there's a medical reason to be checking the eyes – which is anything other than near-sighted or far-sighted – it’s covered under Medicare,” he explains.

While Medicare doesn’t typically pay for glasses or contacts, the one exception is immediately after cataract surgery. “They pay a few hundred dollars towards glasses. That’s the one time,” Dr. Grant laughs.

If you came to Dr. Grant with glaucoma, you’d have two to three appointments per year, and most of your visits and the necessary testing would be covered by Medicare and your Medicare Supplement.

Any out-of-pocket costs you might have would be based on Medicare’s allowable charges.

“Medicare treats eye doctors as just a different kind of specialist,” Dr. Grant explains.

Medicare Coverage for Eye Drops and Eye Medications

Dr. Grant says your Medicare Part D drug plan would help pay for eye drops or medications for the eye. Your coverage would be subject to your specific plan, but most plans offer coverage for tears and certain medications.

Medicare Advantage and Vision Coverage

Dr. Grant says only about 5% of his patients have Medicare Advantage. Most choose Original Medicare and a Medicare Supplement.

We typically recommend Original Medicare with a supplement to our clients, because the Medicare Advantage options in Decatur aren’t very competitive, and the network constraint is usually a concern.

Dr. Grant doesn’t see any notable differences between Medicare Advantage or Original Medicare. “It’s not easier or harder to work with,” he says. “From our perspective, it’s the same.”

Read more: 6 Simple Ways to Tell If Medicare Advantage Is Right For You

Vision Plans for Seniors

There are private insurance plans you can buy for vision and dental coverage. Dr. Grant says they aren’t one-size-fits-all from his experience, and you have to weigh the pros and cons for yourself on whether it’s worth the cost.

“Take a look at how much the plan covers for glasses versus how much the plan costs in premium. If you have a private vision plan that covers $250 per year for glasses and you need glasses every year, maybe it’s worth it.” he explains.

Dr. Grant says the real value of the plan is in how much it pays towards materials like glasses or contacts since Medicare covers almost everything else.

Vision Care Tips

Dr. Grant says the most important tip he can offer to seniors who want to take care of their eyes is to do annual checkups.

“We see things that have gone far too long, and the trouble with the eye is conditions can fester without us knowing,” he says. “If you’ve lost vision, the likelihood of getting it back is not good.”

Preventive testing is the best way to make sure you don’t have any vision problems. The earlier you catch an issue, the more likely you are to retain healthy eyes.

Eye vitamins can also be relevant for certain conditions, Dr. Grant explains, but they aren’t nearly as important as making sure your eyes are protected once a year.

The most important message Dr. Grant has for the older demographic is to get your eyes checked on a regular basis.

“Our eyes are tied into our systemic health. High blood pressure can affect your eyes. Tumors, autoimmune disorders, thyroid disease, brain disorders – these can all show symptoms in the eyes,” he says. “If you get your heart checked a few times a year, get your eyes checked at least once!”

Dr. Bradley Grant is an Optometrist at Mid-State Eye, which has three locations in Central IL including Decatur, Shelbyville, and Clinton. His office has invested in state-of-the-art technology that allows for advanced, comprehensive testing. Dr. Grant is active in the Illinois Optometric Association and American Optometric Association. He currently serves as president of the Central Illinois Optometric Society.