Medicare Coverage of Eye Disease or Injury Care
What It Is
Examination and treatment for an eye disease, condition, or injury
Medicare Part B covers the services of a doctor or laboratory and diagnostic testing for treating an injury, disease, or condition of the eye (just like any other part of the body). This includes treatment, including surgery, for cataracts. However, Medicare Part B doesn't cover regular eye examinations, eyeglasses, contact lens testing, or glasses or lenses themselves (except following cataract surgery).
Medicare Part B doesn't cover self-administered prescription eye medicine. For coverage of such medicine, a patient must have a Medicare Part D prescription drug plan or a Medicare Part C Medicare Advantage plan that covers prescription drugs.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for eye disease or injury care, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the cost of a doctor's services for diagnosing and treating an injury, disease, or condition of the eye.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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