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Getting Vision Care through Medicare and Medicaid


Both Medicare and Medicaid are government sponsored programs that can provide different types of medical care. Vision coverage is provided; however much of the cost and which types of services are included will depend on a number of factors including which type of plan is in effect. Both types of coverage can be very confusing and what makes them even more so is the fact that the states administer their services differently. What is true of one program in Minnesota may not be the same in California, even though the programs have the same names. It is important then that you read the following information as a general guideline and direct your more personalized questions to your local insurance provider's health care professionals.

Medicare
The government-funded Medicare program has several criteria for determining eligibility including: age (you must be 65 or older) and specific disability and income standards. The program is split into four parts, each with different types of coverage and limits. When you enroll should receive information packets which explain your options and coverage types, but if you have any questions, you should contact your local agency on aging for assistance.

Part A: Medicare’s Part A coverage is hospital insurance and covers not only hospital stays but trips to rehabilitation centers, hospice services and some home health care services. This portion of Medicare does not cover any of the preventative treatment for your vision; however it does cover any eye-related trauma, injury or accident that may occur.

Part B: Medicare’s primary health insurance coverage is Part B, which covers any doctor visits that are not covered by Part A. Like Part A, Part B Medicare does not cover preventative eye care, but does cover the care of specific eye diseases.

Part C: Medicare Part C is also called Medicare Advantage (MA) and allows those who are enrolled in either A or B to also join a health plan. Doing so will extend the number and types of benefits that the person is entitled to including some coverage for eye exams, contact lenses or glasses.

Part D: Medicare’s Part D program covers prescription drugs and will cover the cost of prescription eye drops and other medications needed for the treatment of eye diseases and conditions.

If you are enrolled in either Part A or B and need additional coverage, there is Medigap, a supplemental plan that will help cover those expenses not already qualified by either program. If you are enrolled in Medicare Part C, you do not need to enroll in Medigap because it is basically the same type of coverage with many of the same benefits.

Vision Care Through Medicare and MedicaidMedicare Parts A and B both provide for specific vision screening tests for diseases under certain conditions.

Glaucoma screening will done one time a year for the following high risk groups:

  • Diabetics
  • Those with a family history of glaucoma
  • African Americans over age 50
  • Hispanics over the age of 65

Basic cataract surgery is also covered by Medicare.

Medicaid
Medicaid is a program that is set up by the federal government; eligibly is determined by a number of criteria including age, economic status, health and family size. Funding for the program is provided by both the states and the federal government; however each state is responsible for running their own version of the program. The states can provide coverage through private insurance companies or can pay the providers directly. The amount of coverage for vision care is different from state to state with some states providing eye exams and treatment for specific groups while others only offer limited vision screenings for children starting school as part of Well Child programs. In some states there might be a small co-pay for some benefits, for instance some states require a one dollar fee for eye glasses and will not cover any special features. Most states restrict the selection of eyeglass frames as well.

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