Does Medicare Supplement plan N cover eye exams

Does Medicare Supplement Plan N Cover Eye Exams? 

People who need corrective lenses will probably visit their optometrist or ophthalmologist regularly to validate or update their eyewear prescriptions. But the value of these exams extends beyond vision correction. Whether you need eyeglasses or not, annual eye exams are an investment in your overall health, equally as important as proactive physicals and dental hygiene. Also, since 20/20 vision degrades slowly, you may need a pair of glasses and not even realize it. 

A qualified vision specialist is trained to identify markers of eye disease even before you experience symptoms. The Centers for Disease Control and Prevention (CDC) pinpoints common eye diseases, which left untreated can lead to partial or complete vision loss. Four diseases noted are cataracts (clouded vision), diabetes retinopathy (damaged blood vessels), glaucoma (damaged optic nerves) and age-related macular degeneration (light-sensitive tissue breakdown).

Your eye exam

During a preventive eye visit, your doctor will check your eyes for sharpness (visual acuity), alignment, motion and depth perception. The CDC recommends starting routine eye exams early in life beginning with preschool age, 3 to 5 years old, and continuing these checkups throughout your life. 

By dilating (widening) the pupils of your eyes, your doctor is able to see signs of eye disease. Based on the prevalence of optical issues connected with specific populations, the CDC suggests an exam that includes dilation every year for diabetics and every two years for the following populations: 

• African Americans who are 40+ years old.
• Adults over 60 years old, particularly Mexican Americans.
• All people with glaucoma in their family history.

Vision care coverage

Neither Original Medicare nor Medigap covers routine eye exams or corrective lenses, but you may have other options. Many Medicare Advantage (MA) plans offer extended benefits that include vision care as well as dental care and hearing services. Some people opt for a stand-alone vision care plan.  

To find a private stand-alone vision care plan in your area, start by typing keywords in your browser, such as “vision care insurance” with your city and state. When reviewing the search results, be sure to distinguish between insurance coverage and discount programs. Insurance generally involves copayments and allows the provider to bill the insurer directly. If you have a discount plan, you pay agreed-upon reduced rates to the provider at the time of service. 

Medicare benefits for special eye conditions
Medicare Part B does cover eye exams under certain circumstances. If approved, your share is the 20% coinsurance and Part B deductible. Additionally, services rendered in a hospital outpatient setting require a copayment to the hospital. Some Medigap plans, including Supplement Plan N, cover Part B coinsurance. However, Plan N does require that you make a copayment of up to $20 for certain office visits.  

If you are at high risk for glaucoma, you can be tested every 12 months. If you have diabetes, Part B covers an annual exam for diabetic retinopathy. The doctor must be state-approved to administer these tests. 

If you have cataract surgery, Medicare will cover corrective lenses. This includes either a pair of eyeglasses with standard frames or a set of contact lenses. The benefit applies after each surgery when an intraocular lens is implanted. To benefit from the coverage, use only Medicare-approved suppliers.

Resources

To review the basics of vision and eye health, including common issues and frequently asked questions, browse the web pages of the CDC at cdc.gov/visionhealth/basics/index.html. 

If you have an MA plan, check your vision care benefits through the Evidence of Coverage document provided to you by your insurance carrier. If you are preparing to use a stand-alone vision care plan, contact your doctor’s office first to ask if your doctor is a participating member.

Compare Medigap benefits across Plans A through N to find the coverage that meets your needs.