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Does Medicare Cover Eye Exams? Yes, in many cases.
Vision care services are covered by Medicare if they are considered reasonable and medically necessary. Should you have symptoms associated with eye health problems like cataracts, or systemic health conditions like high blood pressure and, diabetes, regular eye exams are recommended.
Our office is a participating provider for Medicare. Basically that means we will bill Medicare and accept payment directly from them if the services qualify for coverage (see exemptions below). We also agree to accept Medicare's fee as the maximum fee we can charge for covered services. You are responsible for paying for any
non-covered services at the time of your office visit. Not all doctors have agreed to be participating providers.
We still find patients that have Medicare that come in unaware that Medicare offers coverage for eye health conditions. When you come in for your eye health examination, we will be happy to explain what Medicare will cover in your individual case.
Medicare requires that you pay the annual deductible toward any qualified services before Medicare will pay for any services. After you meet your deductible, Medicare will pay 80% of the doctor's "approved fee". You will pay 20% as a co-payment, plus any non-covered fees. If you have supplemental insurance (i.e. Plan 65), it may cover the cost of the deductible and co-payment.
What We Do For You
Glaucoma info from Medicare
Medicare Coverage
Diabetes and Medicare
If you need an eye doctor that will actually take the time to thoroughly explain your eye health condition for you so that you can understand it, please call for an appointment to see Dr. Vietti. The phone number is 620-431-0010.
Special Exceptions
1. Medicare does not cover eyeglasses or contact lenses unless you have had cataract surgery. Then, Medicare pays once per each surgery.
2. Medicare does not cover the refraction part of the eye exam. Not even after cataract surgery.
3. Medicare does not cover any services without a medical diagnosis. The need for glasses also is not considered a medical diagnosis.
4. Medicare may deny benefits if it feels you are receiving examinations too frequently or receiving exams by more than one doctor for the same illness.
5. All medical services are subject to a Medicare deductible. We cannot always predict if you have fully paid your deductible for this year. Your response from Medicare will explain covered services, deductibles, and their payment.
6. For covered services, our office cannot bill you until a response is received from Medicare. We will submit your claim and contact you when their response is received.
If you have further questions about Medicare coverage for an eye examination in our office, please call us at 620-431-0010. |
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