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BY IRENE CARD AND BETSY CHANDLER

NEWJERSEYNEWSROOM.COM

YOUR HEALTH INSURANCE

Medicare will not generally pay for routine eye care, but it will pay for some eye care services to detect or treat chronic eye conditions such as glaucoma and cataracts.

Glaucoma is a group of eye diseases in which damage to the nerve located in the back of the eye (the optic nerve) results in loss of eyesight. If glaucoma is not treated, vision loss may continue, leading to total blindness. There is no sure way to prevent glaucoma, I am told, but early treatment helps slow the disease and prevent blindness.

Medicare covers 80 percent of the cost of an annual glaucoma screening if you are at high risk for glaucoma, after you pay your annual Part B deductible. If you have not met your Part B deductible ($135 in 2009), the allowable charge will go toward your deductible. The screening must be performed or supervised by an eye doctor who is licensed to provide this service.

Those at high risk for glaucoma include people with diabetes or high blood pressure, people with a family history of glaucoma, African Americans age 50 and older, and Hispanic Americans age 65 and older.

Medicare will not generally pay for routine eye care but it will pay for some eye care services if you have a chronic eye condition such as cataracts or glaucoma. The portion of the eye exam to determine if you need glasses (or a newer prescription for lenses) is known as a refraction and that is not covered by Medicare. It is covered, however, if you have diabetes. Medicare will pay for a routine exam once every twelve months to check for vision loss because of the diabetes. If you are at high risk for glaucoma, (as explained above) Medicare will cover an annual eye exam every twelve months.

If you have a chronic eye condition such as cataracts or glaucoma, Medicare will cover surgical procedures to help repair the function of the eye due to these conditions. For example, Medicare will cover surgery to remove the cataract and replace your eye's lens with a man-made intraocular lens. Medicare will cover eyeglasses or contacts only if you have had cataract surgery during which an intraocular lens was placed into your eye. Medicare will cover the dark glasses that you must wear immediately after surgery to protect your eyes, and a standard pair of untinted prescription eyeglasses or contacts if you need them after surgery. If it is medically necessary, Medicare may pay for customized eyeglasses or contact lenses. Medicare will pay for an eye exam to diagnose potential vision problems. If you are having vision problems that indicate a serious eye condition, Medicare will pay for an exam to see what is wrong, even if it turns out that there is nothing wrong with your eyesight.

Of course, if you develop a medical problem with your eyes, other than those mentioned above, the exam will be covered by Medicare. An example would be an infection in your eye, or pinkeye (conjunctivitis). There are numerous other instances when Medicare will pay for an eye exam. If you get something in your eye, for example, a splinter, glass, a bug, etc., the exam will be covered.

Irene Card & Betsy Chandler are both licensed insurance professionals working at MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, browse our past columns on our web site at www.micinsurance.com.

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