A Guide to Medicare and Vision Coverage

Your vision is a huge priority. Especially as a senior, eye diseases like glaucoma, diabetic retinopathy, age-related macular conditions, cataracts, and more seem right around the corner.  

Eye health is so crucial that the American Optometric Associated has named March Save Your Vision Month. Celebrate the month of March by staying up to date with all things vision. When it comes to seeing a doctor for your eye health, it can be confusing to determine whether Medicare will cover the visit.  

That’s where Medicare Allies comes in! We care about your health, so we are happy to give you the ins and outs of Medicare and vision coverage.  

Common Eye Conditions in Seniors

Vision loss among elderly seniors is a huge issue. One in 3 seniors over the age of 65 has some sort of degenerative vision condition.  

Glaucoma

Simply put, glaucoma is a disease that damages your eye’s optic nerve. This usually happens because of fluid buildup, which leads to increased pressure, eventually causing damage to the eye.  

Symptoms include:

• Severe headaches and eye pain  
• Blurred vision
• Vision loss  
• Halos around lights  

Glaucoma is a leading cause of blindness in seniors over 65. However, you can prevent vision loss from this condition through early treatment.  

Diabetic Retinopathy

Many of us have heard of diabetes, but it can be surprising to learn that this blood sugar disorder can lead to complications that affect the eyes.

In anyone who has Type 1 or Type 2 diabetes, mainly when it goes unmanaged, damage can occur to the blood vessels of the tissue that processes light in the back of the eye.  

At first, diabetic retinopathy can manifest with no symptoms or only minimal vision issues. However, over time, it can cause blindness.

Symptoms include:

• Spots or dark floaters in your vision
• Blurred vision
• Dark or empty areas in your vision  
• Vision loss

While careful management of your diabetes would be the best way to combat this condition, frequent trips to the ophthalmologist can prevent the onset or worsening of diabetic retinopathy symptoms.  

Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is prevalent in seniors. It is the leading cause of vision loss in people 50 or older.

AMD occurs when there is damage to the macula, which is the back part of the eye that detects light. This can lead to blurry vision as well as more severe vision loss.  

While being a senior puts you at higher risk for AMD to begin with, there are a few other risk factors to avoid, decreasing your chances of getting this condition.  

Risk factors of AMD:  

• Obesity  
• High blood pressure  
• Heart disease
• Smoking  

Fortunately, there are treatments available for age-related macular degeneration, so if you are experiencing symptoms, don’t be afraid to seek your doctor’s guidance. The earlier, the better.

Cataracts  

When you look at your eye, you can see the iris (the colored part). That’s because there is a completely clear lens layered over the top of your eye.  

A cataract is the clouding of the usually clear lens of your eye. For someone with cataracts, looking through that clouding is a bit like trying to see out of a foggy window.  

Cataracts are increasingly common as you get older. More than half of all Americans 80+ either currently have cataracts or have had surgery to get rid of them.  

Most often, cataracts are age-related.

Symptoms include:

• Cloudy or blurry vision  
• Poor night vision  
• Faded colors
• Double vision  

Fortunately, there are safe and effective surgeries that can fix your cataracts, as well as prevention techniques such as frequent eye exams, a balanced diet, and protecting your eyes from UV light.

Read more: Medicare and Cataracts: What You Should Know

Vision Care Tips

As the old saying goes, the best offense is a great defense. By taking care of your vision now, you can help prevent more severe eye conditions as you get older.  

Even if you already have an eye condition, it is never too late to engage in self-care to prevent the worsening of your eye health.  

One of the most vital steps you can take is to protect your eyes from UV rays. Wearing sunglasses doesn’t just make you look cool; it protects your eyes and eyelids from sun damage.  

Other tips include:

• Get your baseline eye exam  
• Eat a healthy diet
• Don’t smoke
• Monitor eye fatigue

Does Medicare Have Vision Coverage?  

In most cases, original Medicare does not cover vision exams, eyeglasses, or contact lenses. This means that if you need any of these services and only have traditional Medicare, you may be stuck paying out of pocket for this care.  

However, Medicare does cover some diagnostic and preventative vision screenings depending on your specific circumstances.  

Additionally, Medicare Part B may cover corrective vision care if you need it after cataract surgery. Medicare Part B also covers glaucoma tests for high-risk patients, certain diagnostic tests for AMD, and eye exams for diabetic retinopathy once a year if you have diabetes.  

Does Medicare Advantage Cover Vision?

Medicare Advantage plans (Part C) often cover additional services that traditional Medicare might not.

Routine eye exams, eyeglasses, contact lenses, and fittings for these health devices may be covered through a Medicare Advantage plan.  

Contact us today to learn more about your options with Medicare Advantage.  

Are DVH Plans for Seniors Worth the Money?

Aside from Original Medicare and Medicare Advantage coverage, there are stand-alone insurance plans that can offer vision coverage.  

Commonly, these are called DVH plans. DVH stands for dental, vision, and hearing plans that cover — you guessed it — dental, vision, and hearing care. Often, these three are bundled together.  

Read more: Dental, Vision, Hearing Insurance

These plans help pay for costs on a sliding scale. With a maximum benefit for the year and a small annual deductible, these policies can be an excellent option for those with preexisting conditions and many medical needs in the dental, vision, or hearing areas. Best of all, these policies do not have underwriting. This means that you do not have to answer any health questions to get coverage.  

However, depending on the deductible, these plans can get pricey. The merit of DVH plans is determined by the wants, needs, and budget of each individual.  

Sometimes, a client would be better off setting aside money each month to pay out of pocket for their care, rather than consistently paying for coverage that may add up to more than their bills.  

Other clients may prefer the peace of mind that comes with a stand-alone DVH plan. If that is the case, Medicare Allies can ensure that you find the best possible plan for your needs while also understanding its limitations.  

In our experience, Aetna’s vision coverage for seniors has been a winner among our clients and continues to be a favorite.

For example, on the Aetna plan, after six months and if your deductible is paid, you get 60% coverage for the first year, 70% for the second year, and 80% coverage for year three and beyond. It also pays for the following:  

• Up to $200 during any two policy years
• Eye examinations
• Eyeglasses
• Contact lenses

Depending on what plans are available in your area and your specific needs, Medicare Allies can help you get the best of all worlds.

Conclusion

There is never a better time to take control of your health than the present. The best way to practice mindfulness about your health is to know what is covered by your insurance plan so that you can operate accordingly.

Join us in celebrating Save Your Vision Month by taking part in preventative measures for your eyes! If you want to step up your coverage or are just curious about how to optimize your benefits, give your trusted Medicare Allies a call.