If you’re having eye problems, you may wonder, is an ophthalmologist covered by my medical insurance or do I need vision insurance? In short, most ophthalmologists accept both medical and vision insurance, depending on the type of services you need. Vision insurance covers your optical needs, such as annual eye exams, eyeglasses, and contact lenses. However, it does not cover any eye services that are considered “medical”. Medical insurance will pay for medically necessary services. So, if you have an eye disease or health problem you can usually use your health insurance for that treatment. Below we’ll look at common eye issues, and what each insurance will cover.
What Is an Ophthalmologist?
An ophthalmologist is a doctor who is an expert in eye care. They are different from optometrists because they are doctors who have spent at least 12 years in school to get their license as an ophthalmologist MD. Ophthalmologists are trained to perform eye surgeries and treat eye disease as well as vision problems. They also train to do vision tests and write prescriptions for eyeglasses and contact lenses. The kind of care you get depends on why you’re going to the ophthalmologist in the first place.
An ophthalmologist can give you glasses or contacts to help you see better, as well as treat cataracts, diabetic eye problems, macular degeneration, and other eye problems. If you’re still wondering, “Are ophthalmologists covered by medical insurance?” you can rest assured that they are. You might see an ophthalmologist for things like macular degeneration or glaucoma, which are both common eye diseases. But if you have a problem with one or both of your eyes, that is the most important reason to go. Some of the most common problems with the eyes are:
Sudden Vision Changes
Some normal changes in vision are caused by genes or getting older. Changes like sudden blurriness or a change in the floaters in your eyes can mean that something serious is going on with your eyes that an optometrist can’t help with.
Double Vision
If you have double vision, it could mean that your nerves are damaged or that the issue may be residing in your brain. An ophthalmologist can look into the problem and find out what’s going on.
Eye Infections
When an eye infection gets worse, it can sometimes make it hard for you to see. The ophthalmologist can figure out what’s wrong and give you the right treatment so that an infection doesn’t hurt your eyes.
Other Eye Specialists
As we’ve already talked about, an ophthalmologist is a doctor who is licensed to treat and operate on the eye. You should always see an ophthalmologist if you have a serious eye problem or if you hurt your eye physically. An optometrist is not a medical doctor. Instead, he or she is a specialist who takes care of the eyes by doing things like testing and correcting vision, as well as treating and managing changes in vision. Most health insurance plans don’t pay for this kind of vision test, but a vision plan might. An optician is a trained person who checks and fits eyeglasses and contact lenses, usually based on what an ophthalmologist or optometrist tells them to do. A vision plan may also cover visits to the eye doctor or optician.
Common Eye Conditions
Proper eye care is important if you want to keep your eyes healthy and keep your eyesight. It’s important to know the most common eye diseases so you’ll notice if your eyes or vision change because of an injury,illness, or just aging. Most eye problems are easier to treat if they are caught early. This is one of the reasons why it’s so important to get an eye exam every year. Below are a few of the most common eye problems.
Vision Impairment
The CDC says that refractive errors are the main cause of eye problems in the U.S. Refractive errors in your eyes cause your vision to be blurry. These errors include astigmatism (distorted vision), myopia (near-sightedness), hyperopia (far-sightedness), and presbyopia (can’t focus on close objects, usually in people 40 and older). These kinds of vision problems can often be fixed with eyeglasses or contact lenses, and sometimes they can be fixed with surgery, like LASIK.
Cataracts
Cataracts, which cloud your eye’s lens are another leading cause of vision loss in the U.S. At first, stronger lighting and eyeglasses can help with cataracts, but most people end up needing surgery. Which can be quite safe and very successful depending on your situation.
Glaucoma
Glaucoma is an eye disease that damages the optic nerve and can lead to either partial or complete blindness. It is usually treated with eye drops, pills, or traditional or laser surgery. The goal with treatment is to keep glaucoma from taking your vision completely.
Macular degeneration
Macular degeneration, which causes blurred central vision, can happen in people over 40. Central vision is needed for daily tasks such as driving or reading so age-related macular degeneration can have a serious impact on your life. There is unfortunately no cure for age-related macular degeneration, but you can. The best steps are exercise, quitting smoking, and eating lots of vegetables.
Diabetic Retinopathy
Diabetic retinopathy can be treated by keeping a person’s blood sugar, blood pressure, and lipid problems under control. An annual eye exam is very important for people with diabetes, and most health insurance plans cover it.
Conjunctivitis
Conjunctivitis is a very common, but not always dangerous, eye problem. Also called “pink eye,” conjunctivitis is an infection or inflammation of the conjunctiva. It can happen to one or both eyes. It can also spread very easily. Conjunctivitis isn’t a very serious eye disease, but if it isn’t treated properly, it can turn into something worse. Depending on what’s causing it (allergy, virus, bacteria, etc.), the treatment is usually topical antibiotics or fake tears.
Amblyopia
This is one of the most common problems kids have with their eyesight. Amblyopia, which is also called “lazy eye” is when the eye and brain don’t coordinate well. One eye gets more attention from the brain than the other. This means that one eye is not being used normally. Amblyopia can lead to blindness if it isn’t taken care of properly when the child is young. But putting an eye patch over the healthy eye, which makes the child use the “lazy” eye, is often a good way to treat the problem. Also, corrective eyeglasses or contact lenses could be part of the treatment.
Strabismus
This is another common eye disease that affects children. Strabismus makes the eyes cross in or turn out. If it isn’t treated, it can also cause blindness. To stop this eye disease from getting worse, treatment should start as soon as possible, sometimes even when the child is only a week old. Also, corrective eyeglasses or contact lenses may be used.
Medical vs Vision Insurance
The main difference between medical insurance and vision insurance is how the treatment you’re getting is classified. When you look at what insurance covers during an ophthalmologist visit, you’ll find that it’s your health insurance. Your vision insurance covers an optometrist visit although it may also cover some services from an ophthalmologist. For example, you go to an eye doctor for a regular eye exam. The optometrist will take your group vision insurance for the visit and any other services you need that are covered by the policy. If the optometrist finds something wrong with your eyes that needs medical care, they will send you to an ophthalmologist. The ophthalmologist will treat the problem. Here’s how each insurance type pays for eye care:
Medical Insurance
When you have medical problems with your eyesight, you need the help of an ophthalmologist to treat and fix them. These are medical problems because you need a doctor to treat them and give you medicine, but not always to give you glasses or other tools to help you see better. Some common medical problems that your doctor can bill your insurance are:
Comprehensive eye exams with dilation (but not the part of the exam that tests your vision, called refraction)
Eye infections
Diabetes eye exams
Monitoring cataracts
Exams if you take medicine with possible side effects on your eyes, such as steroid medicines and arthritis medications
Managing and treating macular degeneration or glaucoma
Emergency appointments due to loss of vision
Under the Affordable Care Act (ACA, also called “Obamacare”), all qualified health plans must cover many eye diseases, such as glaucoma, cataracts, amblyopia, strabismus, diabetic retinopathy, and age-related macular degeneration. All of these are medical problems that your major medical insurance plan will cover. Also, Obamacare-qualified health plans must cover pediatric vision care for all patients under 19 years old, which includes an annual eye exam and, if needed, eyeglasses.
Vision Insurance
Under Obamacare, the vast majority of qualified health plans for adults do not cover eye care. This means that refractive errors or mild but common eye diseases like conjunctivitis may not be covered by your major medical insurance plan. So, what is vision insurance if some types of eye care are covered by medical insurance? Vision insurance pays for eye exams, corrective lenses, eyeglass frames, contacts, and discounts on LASIK, special coatings for lenses, and progressive lenses.
EZ Has You Covered
Regular eye exams are important for keeping your eyes healthy and keeping your eyesight in good shape,even if you’re one of the few people in the U.S. who doesn’t wear glasses or contacts. Your optometrist will check for certain problems every time you go in. Even though a lot of employers offer vision insurance, some don’t. You can find a vision plan that will cost you a lot less per year than paying out of pocket for eye care. Eye insurance is worth the money just because of this. To get started, just type your zip code into the box below or call 877-670-3557 to talk to one of our licensed agents.
As you age, your likelihood of developing cataracts increases. About 30% of Americans 65 and older have some kind of vision impairment from cataracts, and for those over 80, that number jumps to 50%. While Medicare does not cover routine vision care such as eye exams for glasses, it does cover diagnosis and treatment for chronic eye conditions, including cataracts. Cataract surgery is considered a medically necessary surgical procedure, but Medicare will only cover the basics.
The Surgery
Cataracts occur when the lens of your eye becomes clouded. Having this condition makes your vision blurry and less colorful, or like you are looking through a foggy or dusty window. During cataract removal surgery, the surgeon removes the clouded lens and replaces it with an artificial implant. It takes about an hour to perform and can be done in different 2 ways:
Phacoemulsification– A tiny probe is inserted into the lens and ultrasound waves are used to break up the cataract. The particles are then “vacuumed” out.
Extracapsular– The doctor makes an incision in the cornea and lifts out the lens in one piece before replacing it with the implant. You will most likely need stitches after this procedure.
Surgery is normally very successful for the majority of people who get it done. After surgery, you might need to wear an eye patch and use special eye drops to prevent infection.
What Medicare Covers
Medicare will cover your cataract surgery as long as it is deemed “medically necessary” by your doctor. Both traditional and laser cataract surgeries are covered, but if you opt for premium products such as intraocular lens (IOL) implants, then you will have significant out-of-pocket expenses that Medicare will not cover. Medicare will also cover one pair of glasses after cataract surgery.
Medicare covers one pair of glasses after cataract surgery.
The specific list of what Medicare covers includes:
Preoperative exams
Removal of cataracts
Implantation of lens
Postoperative exams
One pair of prescription glasses
How Much Medicare Covers
Cataract surgery can cost about $2,700 for one eye and $5,200 for two eyes, depending on the type of procedure and whether it is done on an outpatient basis or in a hospital. For outpatient procedures, Medicare Part B covers 80% of the costs of the outpatient facility, the doctor’s fees, and other costs related to the surgery, once you meet your deductible.
Medicare’s Part A will cover the hospital stay if your cataract surgery takes place in the hospital instead of an outpatient facility. You will have to pay a separate Part A deductible if your cataract surgery needs an inpatient stay.
Help with Out-of-Pocket Costs
Because Medicare Part B only covers 80% of the cost of the surgery, you will have to pay the remaining 20% out-of-pocket. Having a Medicare Supplement Plan can help you pay this balance. A Medicare Supplement Plan works like any other private insurance plan: you pay monthly premiums and your plan can cover deductibles, copays, and other out-of-pocket expenses. The cost of each plan, as well as the coverage they provide, varies.
Medicare covers 80% of costs, but if you need surgery or any other type of procedure, you could still end up paying hundred of dollars out-of-pocket. It is wise to have a Medicare Supplement plan to help you pay for those out-of-pocket costs. In order to find the right Medicare Supplement Plan for you, you’ll have to compare all the different types, which can be time consuming and confusing. EZ.Insure will help compare all the plans and their costs, and will help you sign up for the best plan for your budget. To get free quotes, enter your zip code in the bar above, or to speak directly to a trained agent, call 888-753-7207.
Take a look around you – what do you see? Maybe you see friends and neighbors chatting outside, a flourishing garden, a beautiful sunset, or a clear blue sky. Our sense of sight is one of the things that keeps us connected to the beauty of the world, and one of the main things that keeps us independent. However, as we age, our eyesight naturally deteriorates. There are some protective measures you can take to support healthy eyes and protect your precious eyesight.
Common Eyesight Changes
Many people report that changes in their eyesight sneak up on them. Because many conditions develop painlessly and have few early symptoms, they often go unnoticed until the condition is quite advanced. But if you are aware of common age-related eye issues and their symptoms, you can identify any red flags and discuss possible treatment with a doctor. Some common age-related eye conditions include:
Floaters. While this might not sound like a scientific term, the term “floater” is used to describe spots, thread-like strands, or squiggly lines that drift around in your field of vision. What you are actually seeing is the shadow of vitreous, the gel substance that makes eyes round. These are usually a harmless and natural part of aging. However, if you suddenly notice a large amount of floaters, loss of peripheral vision, and/or flashes of light, it could mean something more serious and you should seek medical attention right away.
Dry eyes. As we age our eyes stop producing enough high-quality tears to lubricate themselves. This can result in dry eyes, which can cause an itching, burning sensation and red eyes. Eyes that are too dry have an increased risk of infection and tears to the cornea. There are many medical and environmental factors that might contribute to the onset of severe dry eyes, such as menopause, certain medications, and allergies. Dry eyes can usually be treated with over-the-counter eye drops or hot compresses, but see a specialist if this condition becomes painful.
Presbyopia. Presbyopia is a common eye condition that is caused by the muscles around the lens of the eye hardening as we age. Presbyopia makes it difficult to focus on close-up objects, which can result in headaches, eye strain, and difficulty reading small print. A doctor can diagnose and correct this condition with reading glasses.
Cataracts. Half of all Americans have cataracts by the time they are 80 years old. This common condition is characterized as “cloudy vision” – in fact, it can sometimes be visible to the naked eye, with the lens of the eye appearing opaque. Cataracts can cause blurred vision, double vision, decreased visible contrast, decreased low-light vision, and increased light sensitivity and glares. All of these symptoms make driving particularly dangerous, especially at night. Cataracts can be treated with surgery.
High-Risk Eye Conditions
In addition to typical age-related eye changes, there are other health issues that might exacerbate eyesight issues, which can even result in permanent vision loss. People with diabetes are at a greater risk for developing the following optical conditions:
Diabetic retinopathy.This condition is the result of damage to blood vessels in the eye, which causes retinal tissue to swell and creates cloudy vision. At its most severe, diabetic retinopathy can cause blindness.
Glaucoma is a group of eye diseases that cause damage to the optic nerve, impacting peripheral vision. Glaucoma is often painless and can have no obvious symptoms until peripheral vision is impacted. If left untreated, glaucoma can cause blindness.
Retinal detachment. Retinal detachment is a tearing or separation of the retina. This can be caused by trauma to the eye or head, and is found in patients with advanced diabetes.
Protect your eyes
Though the risks are real, there are a few routine adjustments that seniors can make to protect and preserve their eyesight.
Routine medical appointments. Doctors and optometrists alike stress the importance of regular visits to your primary care practitioner and all medical specialists – including optometrists. With routine visits, your medical team will be able to keep tabs on any developments in your health and intervene at the first sign of an issue. This is particularly pertinent for people with additional health risks, such as diabetes.
Make sure to protect your eyes when you are outside in the sun.
Follow medical advice. The World Health Organization reports that 75% of adults need glasses, but many people say that they “should wear glasses, but don’t.” If a medical expert prescribes something – a medication, lifestyle adjustment, or glasses – it’s important to make sure you are following their orders!
Make household adjustments. In addition to following medical protocols, there are some easy adjustments you can make around the house. Instead of reading by a dim light, try switching to fluorescent light bulbs or listening to an audio-book to reduce eye strain. You can also increase the font size on your computer and phone as well as increase the brightness on your screens.
Lifestyle changes.We know that many eye issues are age-related. We can’t stop aging, but we can make it healthy and painless by exercising regularly, eating a healthy and balanced diet, protecting our eyes and bodies from harmful UV rays, and quitting smoking.
There are some real – and scary – age-related eye health issues. But you don’t have to live in fear of losing your sight! By making the necessary adjustments, checking in with doctors regularly, and maintaining a healthy lifestyle, you can preserve your vision for many years to come.
The number of people with diabetes has risen from 108 million to 422 million in only 35 years, and the rate of increase is getting worse. Diabetes affects the body’s ability to produce or use insulin to control blood sugar levels. If blood sugar levels are high for a long time, it can damage essential organs, including the eyes. Diabetic retinopathy can cause blindness, and lead to other blinding eye diseases. So, if you have
Diabetic retinopathy is the leading cause of blindness in American adults. The eye disease causes vision loss and blindness in people with diabetes.
diabetes, prevention is key.
Diabetic Retinopathy
Diabetic retinopathy is an eye disease that causes vision loss and blindness in people with diabetes. It is the leading cause of blindness in American adults. Blood vessels in the retina, the light-sensitive layer of tissue at the back of the eye, will swell, leak, or close off. Abnormal blood vessels can grow on the retina’s surface as well. Early stages of this disease do not usually have symptoms.
During the later stages of diabetic retinopathy, blood vessels in the retina will bleed and leak into the vitreous. A sure sign this has happened is when a person sees dark, floating spots or streaks. If you do not treat it in time, the bleeding will continue, worsening the condition, and cause scarring. Diabetic retinopathy can lead to other serious eye diseases such as:
Diabetic Macular Edema- Over time, half of people with diabetic retinopathy will develop diabetic macular edema. This is when small blood vessels in the center of the retina, called the macula, leak and cause swelling in the retina. It will cause a person’s vision to become blurry, and can lead to permanent vision loss.
Cataracts- Diabetes makes you 2-5 times more likely to develop cataracts because of the high blood sugar levels. A cataract is when the eye’s lens clouds, causing blurriness. Luckily, it can be treated with surgery.
Glaucoma- Diabetic retinopathy causes abnormal blood vessels to grow out of the retina and block fluid. The fluid is not able to drain from the eye, causing glaucoma. The optic nerve is damaged and leads to irreversible vision loss.
Symptoms
About 2 in 5 Americans with diabetes have some form of diabetic eye disease. Symptoms inclue cloudiness, blurred vision, flashing lights, or seeing spots.
To reiterate, the symptoms of diabetic retinopathy can include:
Blurry vision
Flashing lights
Cloudiness
Dark or floating spots
Blind or blank spots
Risk Factors
If a person has diabetes, they are at risk for developing diabetic retinopathy. This includes people with type 1, type 2, and gestational diabetes. The longer that a person has diabetes, the more likely they are to develop diabetic retinopathy. About 2 in 5 Americans with diabetes have some form of diabetic eye disease. High sugar levels affect your eyes greatly.
There are usually no warning signs for diabetic eye diseases, but if you go for regular eye exams, it can be caught early. Make sure to schedule yearly eye exams, and if you have moderate to severe retinopathy, then an exam should be scheduled every 6-12 months. In order to lower your risk of diabetic eye diseases, it is important to manage your diabetes. Having high blood pressure and high cholesterol increases your risk. Keep blood sugar levels as normal as possible, eat healthy, and exercise every day, this will help you control diabetes, blood pressure, and cholesterol levels.
