why won't Medicare cover eye refractions?

[CTyankee]

My eye docs office tells me I have to pay $50 for refraction which is part of my annual eye exam. Medicare won't cover it and my AARP supplemental doesn't (because Medicare doesn't). When I asked if I could just have the eye exam alone, the receptionist was surprised and asked me "Why are you having the exam in the first place if you don't want to see if you need a new prescription for your glasses?"

Now I'm confused. Is all this (or most of it) just for the sake of getting updated glasses? My mother had glaucoma so I am at risk and need that part of the eye exam.

I understand that Medicare doesn't cover glasses, but this puzzles me...in a way I guess the receptionist was right but it bothers me...

[ensho]

1. and why doesn't it cover dentists?

nt

[CTyankee]

3. Meanwhile, my monthly AARP payment went up (after only 6 month of

coverage at the old rate).

It makes me furious that we seniors are told we are greedy and don't want to "pay" for our health care! We pay a LOT just to keep from having a catastrophic medical bill...

[Uben]

6. What is a lot?

I pay OVER $20K/yr just in premiums for my wife and I. That's all, as long as neither of us get sick. The most I could pay out of pocket is a little over $40K if we both had to max out.

Is that a lot? It's draining me faster than the Morganza Floodgates!

[CTyankee]

13. I haven't done the math but our monthly medical premium is $419 and we each have the Medicare

monthly premium, plus the Medicare Part D monthly premium, both of which come out of our SS checks. Luckily, I have only 2 (generic) prescriptions but my husband has a lot more...

[Uben]

15. My premiums are over $1800/mo

My wife had cancer eight years ago. The policy has a $5K deductible and 50% of the next $10K, for each of us.

Who ya gonna call?

I could go without it, but a reoccurrence bankrupts me faster than paying the ransom, er......premiums.

[RC]

9. And why doesn't it cover hearing aids?

Are not our healthy functioning eyes, ears and teeth part of our general health?

[CountAllVotes]

16. because a hearing aid is an "appliance"

Medicare doesn't pay for this type of an "appliance". In other words, they don't care if you can hear or not; seems critical to me.

Alas, we are finally touching upon the many things that Medicare (that thing being demanded for everyone) doesn't pay for a lot of things. Teeth, hearing aids, and eyes aren't important I guess.

This makes me sick really as my husband is slowly going blind requiring injections into the one eye he can still see out of every 6-8 weeks. The ophthalmologist gave him a new RX for glasses for his one eye and wrote that expense off luckily. The ophthalmologist is raking in $600.00+ for every shot to the eye that my husband gets. You'd think that checking the quality of his vision would be mandatory given what is going on wouldn't you?

:dem:

[frazzled]

2. Refraction is just testing for your prescription, and is considered "routine"

not medical. Medicare doesn't pay for routine eye exams, but it would pay for a glaucoma exam.

[CTyankee]

4. I understand that, but the receptionist made it seem like the eye exam was

almost completely about the presription strength of your glasses...surely, there is more to it than that.

[bluedave]

5. Do they pay

for cataract surgery? I'm too broke to pay the $9000 and 63

[CountAllVotes]

7. yes they do

My late mother had cataract surgery before she passed away. She was on Medicare and had a supplemental insurance plan.

:dem:

[CountAllVotes]

8. Medicare does not cover refractions

I guess it isn't considered "necessary".

What many people around where I live do is go to COSTCO and have the eyes tested there for $40.00 and pick-up a new pair of glasses if needed.

It sucks and I don't understand it either. Many vision problems are detected when a simple refraction is done.

[CTyankee]

12. That's exactly my point. I'm going to find out how much the "exam" would cost

without refraction, to see what "is" medical...

[CountAllVotes]

14. an option

What I recently did is went to an optometrist that takes Medicare. I went to him because I was having pain in my eye and I thought something was wrong as I have serious vision problems (you'll often notice that I go back and edit most things I post). He checked my eyes out really good (took almost 1/2-3/4 of an hr.). After this I asked him how much he wanted for a refraction.

Being he was billing Medicare for the eye pain problem, he said $17.00 which I gladly paid. You might try to find an optometrist that takes Medicare and tell said optometrist that you have some sort of a medical issue going on with you eyes and then ask him how much does he want for a refraction. Said optometrist might give you a "deal" so to speak on that part of the exam. Medicare will pay for that, the medical issue part only. This was quite recent btw.

Best of luck to you.

[CTyankee]

17. Thanks. I think I'm going to shop around.

This eye doc is part of a chain, so I always assumed it was "cheaper." I'm wondering now if I can get a better deal elsewhere just by calling around to some places and asking what they charge just for the refraction. I don't have a serious problem but since my mother had glaucoma I am at risk and need the eye exam for medical purposes every year.

[CountAllVotes]

18. well in my case ...

The eye pain which I have seen an ophthalmologist for in the past is mostly due to what they call "dry eye" in part fortunately.

However, the pain I experienced when I managed to get the appt. with the local optometrist that takes Medicare was severe at the time and I've had pain in the eyes cause blindness in the past. I was really worried/freaked out and luckily he had an opening that afternoon and got me right in. The pain was deemed to be mostly from allergies (thank god for that).

That said, my husband went to this same man before he found out he had wet AMD. He noticed his eyesight had changed and thought he needed new glasses. Upon examination, it showed that most of the vision in the eye was GONE. He was advised to go to the ER, which is what he did. Thank god this man was around to see him!

Maybe you could tell the optometrist that you have a medical issue (like pain; a symptom of glaucoma). I'd call up some optometrists and ask if they take Medicare firstly; then ask how much for a refraction.

I suspect this man I went to (who is in practice with his wife) has some advanced training of some sort for Medicare to pay his bill. :shrug:

I hope this helps.

[CTyankee]

19. You sure did help! I would never have considered asking around but thanks to

your telling me of your experience, I learned something!

THANK you!

[CountAllVotes]

20. very welcome

I know how very important eyesight is. You are very screwed if you cannot see. I hope you are ok and that they find nothing wrong.

My husband recently developed glaucoma and there is pain associated with it. :(

Best of luck and glad I can help! :)

[OHdem10]

10. Over the years, as taxes have been cut--cuts had to be made

else where in the budget. Guess what, Medicare had to
cough up benefits.

If you could compare the coverage by Medicare in earlierr
times and now you might be shocked. At one time Medicare
covered all eye exams and glasses.

[damntexdem]

11. Because lawmakers have been too chintzy in the past.

And the politics of the situation is even worse now.

[Manifestor_of_Light]

21. I wonder if Medicaid covers glasses for little kids.

i started reading at age three. I have always been very nearsighted. My mom wondered why I always had my nose in a book. Then in the second grade, she finally took me to an eye doctor and found out I was really nearsighted.

I usually wear glasses so i can take them off to read the micro-print on bottles which is impossible for me to read with glasses.

In Texas they have to do hearing, vision and speech screenings when they are five or six.