The coverage for eye health care varies according to the health plan you have.
HMOs
Most HMOs will pay for much of your eye care after you meet any deductible
payment. Routine eye exams (checkups), including refraction for
new glasses, are usually covered, as is treatment of any eye disease
after
a referral from your primary care physician. The costs of eyeglasses
and contact lenses are not usually covered, although there is often
discount on them. Some plans have a “vision rider”,
and will pay for them completely. HMOs do not usually pay for low-vision
exams or devices.
Medicare
The extent of coverage for eye examinations varies by state. Usually, routine eye exams for refraction are not reimbursable, nor is the cost of eyeglasses and contact lenses. However, Medicare will cover some preventive eye tests and screening, such as glaucoma screening, if you are eligible and have met the deductible. If you have been diagnosed with an eye disease, even in an early stage, Medicare will pay for future visits to the eye doctor and for any treatments considered necessary, for example, photodynamic therapy with verteporfin for wet AMD.
Medicaid
Medicaid has limited coverage for eye health; however financial aid is available for eye care if you meet certain income requirements. The National Eye Institute provides information that can help you find
out if you qualify for free or low-cost eye screenings from eye care
professionals in your area.
Low Vision
Low vision refers to partial or impaired vison that can’t be corrected
by conventional prescription glasses, medical treatment, or surgery. But there
is hope for regaining some useful vision through the use of low vision aids.
You may be a candidate for these aids if you have sustained considerable central-vision
loss due to AMD (the disease causing about half of low-vision cases) or retinal
damage because of other diseases (such as glaucoma, diabetic retinopathy, or
retinitis pigmentosa) or injury, and want to lead as normal a life as possible.
Start by getting a a low-vision evaluation by an optometrist or an ophthalmologist
who specializes in low vision rehabilitation. Available low vision devices
range from simple magnifying glasses, through video magnifiers for reading
and computer work, to customized bioptic telescopes imbedded in eyeglasses.
These aids may allow people to read, watch TV, and in some cases, even drive.
See information from the National Eye Institute, and several other websites:
http://www.ama-assn.org/ama/pub/category/2379.html
Medicare may (depending on state) cover low vision evaluation, training, and therapy provided by physicians, optometrists, and occupational or physical therapists if rehabilitation services are prescribed by these professionals. However, the costs of low vision aids, that is, the devices and materials that enable people to use their remaining vision usefully, are not covered. This may change in the future if enough demand is apparent.
