Does Medicare Cover Eye Surgery?
If you have Original Medicare (Medicare Part A and Part B), you may be covered for eye surgery costs deemed medically necessary by a doctor or ophthalmologist. This includes cataract surgery, the most common eye surgery that Medicare will cover. However, Medicare does not cover routine eye exams and corrective eye surgeries (like LASIK eye surgery) because they are not deemed medically necessary.
What Types of Eye Surgery Does Medicare Cover?
Medicare Part B typically provides coverage for various eye surgeries that are medically necessary, such as corneal transplants and diabetic retinopathy procedures. If any medical equipment, like a laser device, is required during the surgery, it may be covered by Part B.
Original Medicare may also cover other types of eye surgeries, including:
- Cataract Surgery: Original Medicare covers cataract surgery – including one pair of eyeglasses or contact lenses after the surgery.
- Glaucoma Tests: Part B covers an annual glaucoma test for people at high risk for the disease.
- Macular Degeneration Treatment: Coverage includes certain preventative tests and treatments for age-related macular degeneration.
- Corrective Eye Surgeries: Medicare may cover surgeries to correct eye function affected by diseases or injuries, not including refractive or cosmetic surgeries.
- Prosthetic Eye Care: Medicare may also cover the cost of care related to prosthetic eyes, including polishing and resurfacing.
Before making any appointments, make sure your doctor accepts Medicare assignment, which will allow you to use your Original Medicare coverage. You may have to pay a copayment on certain covered services.
What Types of Vision Services Are Not Covered?
While Medicare covers a range of eye surgeries deemed medically necessary, there are certain eye conditions it typically does not cover. These largely fall into the category of elective or cosmetic surgeries.
Eye conditions not covered by Medicare:
- LASIK: This popular surgery corrects vision in nearsighted, farsighted, or astigmatic people. Medicare does not cover LASIK as it’s considered a refractive surgery, which is not medically necessary.
- Eye Exams for Glasses: Routine eye exams to check for eyeglasses or contact lens prescriptions are not covered.
- Cosmetic Eye Surgeries: Procedures such as eyelid lifts, often performed for cosmetic reasons, are not covered unless deemed medically necessary.
- Prescription Eyewear: Medicare does not cover the cost of eyeglasses or contact lenses, except for one pair after cataract surgery.
- Routine Vision Care: Medicare does not typically cover regular check-ups and preventive eye care.
While this list provides general guidance, individual coverage can vary. Always consult your Medicare advisor or healthcare provider to understand what is and isn’t covered under your plan.
What Does Medicare Advantage Cover?
Medicare Advantage (Part C or Medicare HMO) is an alternate choice to Original Medicare. Many Medicare Advantage plans cover additional eye-related tests and treatments not covered under Original Medicare. Each plan’s coverage depends on your plan, so you must check with your healthcare provider before scheduling surgery to ensure your plan covers the specific procedure.
The type of surgery Medicare covers depends on your plan and medical necessity. If you have Original Medicare, it may cover certain medically necessary surgeries such as cataracts, glaucoma tests, and macular degeneration treatment.
Certain types of surgery are typically not covered under Original Medicare, including LASIK, routine exams for glasses, cosmetic surgeries, prescription eyewear, and vision check-ups. However, some Medicare Advantage plans may offer additional coverage.
What are the criteria for Medicare to pay for eye surgery?
Medicare will cover the cost of eye surgery if it is medically necessary and considered reasonable and crucial for your health.