Eye Care for Seniors in NYC: Medicare, Medicaid, and What’s Covered After 65

Eye health becomes increasingly important after sixty-five. The risk of cataracts, glaucoma, macular degeneration, and diabetic retinopathy all rise substantially with age — and in New York City, where more than one million residents are sixty-five or older, navigating Medicare and Medicaid to access appropriate eye care can be genuinely confusing.

What Original Medicare Covers for Eye Care

Original Medicare — Parts A and B — does not cover routine eye exams for glasses or contact lenses. Part B covers eye care only when it is medically necessary, meaning related to a diagnosed eye disease or condition. Medicare Part B does cover:

• Annual dilated eye exam for diabetic patients: One exam per year for Medicare beneficiaries diagnosed with diabetes
• Glaucoma screening: One annual exam for high-risk patients including Black Americans fifty and over, Hispanic Americans sixty-five and over, and patients with family history of glaucoma
• Age-related macular degeneration treatment: Including intravitreal injections such as Eylea and Lucentis
• Cataract surgery: Including one pair of corrective lenses immediately following surgery
• Treatment for other medically diagnosed eye conditions

How to Get Vision Coverage After 65

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers approved by Medicare and must cover everything Original Medicare covers. Many also include supplemental vision benefits — annual eye exams, glasses allowances, and contact lens coverage. Plans available in NYC through EmblemHealth, MetroPlus, and Healthfirst frequently offer competitive supplemental vision coverage.

Dual Eligibility: Medicare Plus Medicaid

New Yorkers who qualify for both Medicare and Medicaid have access to a comprehensive benefit package where each program covers what the other does not. Medicaid covers routine eye exams and glasses that Medicare excludes. Many dual-eligible patients in NYC are enrolled in a Dual Special Needs Plan (D-SNP) that coordinates both benefits within a single plan.

Eye Conditions Most Common After 65

• Cataracts: Affects more than half of Americans by age eighty. Cataract surgery is covered by Medicare Part B
• Age-related macular degeneration: The leading cause of vision loss in Americans over sixty
• Glaucoma: Risk rises substantially after sixty-five. Annual screening is essential
• Diabetic retinopathy: Affects approximately one in three diabetics over sixty-five. Annual dilated retinal exams are Medicare-covered
• Dry eye disease: Affects up to seventy-five percent of adults over sixty-five