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Reply to Medicare and Cataracts /future Eye Exams     
Old 02-27-2015, 01:46 PM   #1
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jeffdcar on Medicare and Cataracts /future Eye Exams
 
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Medicare and Cataracts /future Eye Exams Medicare and Cataracts /future Eye Exams
I know after cataract surgery you may qualify for a one pair of eyeglasses, but what about an annual eye exam? thanks
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Old 02-27-2015, 01:57 PM   #2
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WCMason on Medicare and Cataracts /future Eye Exams
 
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Medicare and Cataracts /future Eye Exams
Originally Posted by jeffdcar View Post
I know after cataract surgery you may qualify for a one pair of eyeglasses, but what about an annual eye exam? thanks
The only condition I've heard that has covered annual eye exams is diabetic retinopathy for anyone with a diagnosis of diabetes.
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Old 02-27-2015, 03:07 PM   #3
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Medicare and Cataracts /future Eye Exams
Originally Posted by jeffdcar View Post
I know after cataract surgery you may qualify for a one pair of eyeglasses, but what about an annual eye exam? thanks
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.
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Old 02-27-2015, 06:00 PM   #4
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Medicare and Cataracts /future Eye Exams
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.
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Old 03-04-2015, 12:26 PM   #5
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Medicare and Cataracts /future Eye Exams Re: Medicare and Cataracts /future Eye Exams
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.
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Old 03-04-2015, 12:35 PM   #6
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WCMason on Medicare and Cataracts /future Eye Exams
 
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Medicare and Cataracts /future Eye Exams
Originally Posted by GoPokes View Post
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.
100% for glaucoma screening limited to high risk candidates. 80% after the Part B deductible for treatment.
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Last edited by WCMason; 03-04-2015 at 12:57 PM.
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Old 03-04-2015, 04:19 PM   #7
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Medicare and Cataracts /future Eye Exams
Originally Posted by GoPokes View Post
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.
Plan J used to pick up the eye test, since it used to cover some "non-Medicare" covered services.
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Old 03-04-2015, 05:28 PM   #8
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Medicare and Cataracts /future Eye Exams Re: Medicare and Cataracts /future Eye Exams
Originally Posted by cadylou View Post
Plan J used to pick up the eye test, since it used to cover some "non-Medicare" covered services.



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.)
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Old 03-04-2015, 05:52 PM   #9
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Medicare and Cataracts /future Eye Exams Re: Medicare and Cataracts /future Eye Exams
Originally Posted by yogooglethis View Post
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.)
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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