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Does Medicare Cover Diabetic Eye Exams?

Older woman during an eye exam
By Daniel Petkevich
Jan 11, 2023

You've got coverage for one exam each year

Treating your diabetes can be overwhelming, especially considering the cost of insulin. While Medicare does not typically cover routine eye exams, there is an exception for screening diabetic retinopathy. You will have coverage for a one exam each year through Medicare Part B.

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What is Medicare Part B (Medical Insurance)?

Medicare Part B (Medical Insurance) helps cover medically necessary services, like doctor's services and outpatient care. It also covers preventive services to help maintain your health and manage chronic conditions. This includes an annual eye exam for diabetic retinopathy if you have diabetes.
Your Medicare-approved eye doctor will check the back of your eyes (retina) to look for signs of damage from diabetes. This eye exam must be done by an eye doctor who is legally allowed to do the test in your state. Medicare Part B covers this eye exam annually for those with diabetes.

What services are covered by Medicare Part B for diabetic retinopathy exams?

Medicare Part B covers one eye exam for diabetic retinopathy each year if you have diabetes. The exam must be done by an eye doctor legally allowed to do the test in your state. This eye exam helps your doctor detect any signs of damage from diabetic retinopathy. Your doctor will check the back of your eyes (retina) for signs of diabetic retinopathy. If the doctor finds any damage, they'll recommend treatment to help prevent vision loss and other complications caused by diabetes.

Who can perform the exam and where?

The eye exam for diabetic retinopathy must be performed by an eye doctor who is legally allowed to do the test in your state. You should contact your Medicare-approved provider to find out if they offer this service and where it can be performed.
It's important to keep up with your recommended screenings, as early detection of diabetic retinopathy can help prevent vision loss. Knowing what is covered by your Medicare Part B plan can help you get the care you need to stay healthy.

How often should you get an eye exam for diabetic retinopathy?

If you have diabetes, you should get an eye exam for diabetic retinopathy once a year. This exam is vital to help detect any signs of damage from the disease and help keep your eyes healthy. Regular check-ups, prompt diagnosis, and treatment can reduce the risk of vision loss from diabetic retinopathy.

Tips to prepare for your appointment

  1. Make sure to bring your Medicare card or other insurance cards and any paperwork needed for your appointment.
  2. Don't forget to mention if you have diabetes when making the appointment so they can set aside enough time for the exam.
  3. Bring a list of all current medications, including vitamins and supplements, that you are taking to the appointment.
  4. Wear your corrective lenses, if needed, so that your doctor has an accurate view of your eyes.
  5. Have a friend or family member come with you for support and help ask questions at the end of the exam.
  6. Ask any questions you have about the exam process or what to expect.
  7. Write down any instructions from your doctor about follow-up care or tests after the exam is completed.
By taking these steps, you can help ensure that your eye exam for diabetic retinopathy goes as smoothly as possible and helps maintain your eye health.

Know the risks

Risk factors associated with diabetes and vision loss include the duration and degree of glucose control, age, gender, ethnicity, and family history. Be sure to talk to your doctor about any risk factors you may have and how they can be managed. Early detection is critical in preventing vision loss due to diabetic retinopathy.

Symptoms of diabetic retinopathy

Diabetic retinopathy usually has no signs or symptoms in its early stages. That's why it's essential to have regular eye exams as your doctor recommends. Late-stage diabetic retinopathy can cause vision loss if not treated promptly. Some common symptoms of late-stage diabetic retinopathy include:
  • Blurry or distorted vision
  • Difficulty seeing at night
  • The presence of floaters in your vision field
  • Sudden vision loss
If you experience any of these symptoms, contact your doctor immediately to get the care you need.

Resources available to help manage diabetes-related vision issues

There are many resources available to help you manage diabetic retinopathy and other vision issues related to diabetes. Talk to your doctor about any questions or concerns you may have about managing your health and finding support. They can provide helpful information on organizations that specialize in providing assistance for those with diabetes-related vision problems. The

American Diabetes Association (ADA)

is a great resource for information on diabetes-related vision problems. They offer free online services such as education and support groups, nutrition advice, and more.

Conclusion

This content is for informational purposes only and does not constitute medical advice. It is important to speak with your healthcare provider about any questions or concerns related to eye exams for diabetic retinopathy, risk factors, and resources available to help manage diabetes-related vision issues. Keeping up with recommended screenings can help detect signs of damage caused by diabetic retinopathy and reduce the risk of vision loss. Talk with an expert at Fair Square Medicare for all your Medicare questions.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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