Does Medicare Cover Refraction?

In this article...
  • Find out when Medicare is likely to cover the cost of refraction testing during routine eye exams. Learn what refraction tests are and why they're important.

The American Academy of Ophthalmology recommends that everyone aged 65 years and older undergo an eye exam at least once every year. During a routine eye exam, doctors perform a variety of tests to assess your eye health and determine if you need corrective lenses. Refraction is normally one of the diagnostic tests included in eye exams. Medicare may help cover some of the cost of the test if you meet certain criteria.

Does Medicare Cover Refraction?

For most people, refraction is considered part of a routine eye exam. Generally, Original Medicare (Parts A and B) doesn't cover the cost of routine eye exams.

If you have diabetes, Medicare Part B will usually cover one routine eye exam per year. Because refraction is typically included in a routine eye exam, your Medicare Part B plan is likely to cover it, provided you choose a doctor who is licensed to perform the test in your state.

Do Medicare Advantage Plans Cover Refraction?

Medicare Advantage Plans must at least match the coverage of Original Medicare. As a result, your plan is likely to help cover the cost of annual routine eye exams if you're diabetic.

Some Medicare Advantage Plans provide additional vision coverage. You can contact your insurance provider to determine if routine eye exams are covered expenses under your plan. Depending on the type of insurance you have, you may need to choose a doctor in your plan's network to receive vision benefits.

What Does Refraction of the Eyes Mean?

In ophthalmology, refraction refers to how light bends as it travels through the cornea and lens of your eye. If you have a refractive error, light can't properly focus on your retina due to the shape of your eye. This can lead to:

  • Astigmatism: Blurriness and distortion of both distant and close objects
  • Farsightedness or hyperopia: Blurry close-up vision
  • Nearsightedness or myopia: Blurry distance vision
  • Presbyopia: Blurry close-up vision usually associated with age

Roughly, 150 million people in the United States have refractive errors, according to the National Eye Institute. Corrective lenses are used to address refractive errors and correct vision.

What Is a Refraction Test?

A refraction test allows an optometrist to determine what power of lens is needed to correct a refractive error. During the test, a doctor usually places a device called a phoropter in front of your eyes. Normally, you're instructed to look at and read a series of letters displayed on a screen or wall across the room. During testing, the doctor flips through different strength lenses inside of the device to make the letters either blurrier or clearer. While you read, the optometrist measures how the lenses affect your eyes with a device called a retinoscope. At the end of the test, the doctor uses the data gathered to determine your prescription for corrective lenses.

Is Eye Refraction Necessary?

Eye refraction testing is necessary for people who suffer from refractive errors. Without the test, your doctor can't prescribe eyeglasses or contact lenses to improve your vision. Refractive errors can grow worse over time, leading to changes in your prescription. For people with certain eye conditions and diabetes, refraction testing can help doctors monitor changes in vision that might suggest modifications to treatment are required.

How Much Does a Refraction Test Cost?

The cost of a routine eye exam with a refraction test depends on where you live, how much the doctor charges and what other tests are performed. Vision Center reports that costs typically range from approximately $50 to $250, with a national average cost of about $95.

How Much Will I Pay for Refraction With Medicare?

If Medicare Part B covers your eye exam, your plan usually pays for 80% of the cost, and you're responsible for the remaining 20%. With Medicare Advantage Plans, a copay or coinsurance is typically required. Both types of Medicare plans often have a deductible that you must pay before coverage begins.

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