Medicare and Cataracts /future Eye Exams

Discussion in 'Senior Insurance Forum' started by jeffdcar, Feb 27, 2015.

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  1. jeffdcar
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    jeffdcar Well-Known Member

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    I know after cataract surgery you may qualify for a one pair of eyeglasses, but what about an annual eye exam? thanks
     
  2. WCMason
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    WCMason Well-Known Member

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    The only condition I've heard that has covered annual eye exams is diabetic retinopathy for anyone with a diagnosis of diabetes.
     
  3. melmadhav
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    melmadhav Active Member

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    Medicare will only cover eye exams that are medical in nature. If the annual eye exam is for a renewal of eye glasses and billed as such then it will not be covered. If the exam is billed with a diagnosis code them it is covered, considering of course that diagnosis code is a covered Medicare code.
     
  4. cadylou
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    cadylou Well-Known Member

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    If the exam covers screenings for glaucoma and other "diseases" of the eye, those are covered. The refractive test which is to devise the prescription for corrective lenses is not. So, for someone with a full exam who has a med supp that covers the difference, the insured will stop have to pay for the refractive test. The bills I've seen separate it out as a line item that runs the client about $38 - $50, depending on what the provider charges.
     
  5. GoPokes
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    GoPokes Well-Known Member

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    My understanding is that it covers 100% for cataract and glaucoma related illness, so if the eye doctor bills it as related to one of those, then it will covered. I've had customers tell me that they get eye exams each year and they don't pay for it, so I assume the doctor is billing it as something related to cataracts... I think I asked my optometrist about this a few years ago and he gave me a similar answer.
     
  6. WCMason
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    WCMason Well-Known Member

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    100% for glaucoma screening limited to high risk candidates. 80% after the Part B deductible for treatment.
     
    Last edited: Mar 4, 2015
  7. cadylou
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    cadylou Well-Known Member

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    Plan J used to pick up the eye test, since it used to cover some "non-Medicare" covered services.
     
  8. yogooglethis
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    yogooglethis Well-Known Member

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    Either it was an AARP plan J which has value added optometry benefits for being an AARP member or if was another carrier maybe they also had some type of value added benefits but plan J never specifically covered routine optometry services.Only non medicare covered core benefits covered on J is at home recovery and preventive( before medicare started covering preventive.)
     
  9. cadylou
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    cadylou Well-Known Member

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    I had people on Mutual of Omaha plans that covered it, so I guess I should have been more specific. I didn't realize that all "J" plans didn't necessarily cover that. Sorry . . . .
     
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