When you visit your optometrist or ophthalmologist to get a new eyeglass prescription, you have what is called a refraction exam. This is basically a vision test that determines whether there is a problem with the way light rays focus as they are passing through the cornea and retina of each of your eyes. These abnormalities are commonly known as farsightedness, nearsightedness, and astigmatism.
A refraction exam helps your physician determine if you need prescription lenses, or a change in your current prescription lenses. It also helps the physician diagnose the presence of eye disease in some instances.
During a refraction exam you look through a phoropter at letters on a chart. Using this machine, the optometrist switches back and forth to different lenses and you decide which one makes the letters on the chart appear sharper to you. This is how the physician determines your optimum lens prescription to attain 20/20 vision, or as close to that as possible.
Because a refraction exam is most commonly associated with routine annual vision checks, your Original Medicare coverage may not cover the costs. However, some Medicare insurance plans may cover these type of eye exams in certain circumstances. It is important to find out the details of what coverage you have with your Medicare insurance policy.
Medicare Coverage of Refraction Exams
Through Original Medicare, you may not have coverage for routine eye exams, also known as eye refractions. Your Original Medicare insurance does not cover the cost of eyeglasses or contact lenses in most instances either. In most cases, you must pay 100 percent of the cost for exams and eyeglasses or contacts.
If you are diabetic and have Original Medicare Part B (medical insurance), your policy includes coverage for diabetic retinopathy exams one time per year. In this case, Medicare coverage with Part B pays for 80 percent of the physician’s fee if the medical provider accepts Medicare assignment. You pay 20 percent of the Medicare-approved amount for the services, as well as the Part B deductible. If you receive the services as an outpatient in a hospital, you may be responsible for the copayment.
If you have a Medicare Advantage (Part C) plan, your policy may have extra benefits that include vision coverage, including routine eye exams like refraction tests. If you are unsure about what benefits you have with your Medicare Advantage plan, you can call a representative of the company that provides these benefits.
If your Medicare Advantage policy offers coverage for routine annual eye exams, you may be responsible for paying a copayment or coinsurance amount. Also, your policy provider may require that the optometrist or ophthalmologist is in your plan’s network of physicians.
Costs of a Refraction Test
If you are paying for an eye exam that includes a refraction test, it is important to have an idea of what your out-of-pocket costs are beforehand. As with most medical exams, there are several determining factors for the final cost. Where you live, who does your exam, and what tests the visit entails, make a difference in the price you pay.
Your first visit to a physician or clinician is generally more expensive than consequent visits. The national average for an initial vision exam is approximately $200.00. Once you become an established patient, the annual exam fee averages at $128.00 in the United States. A refractive vision test alone costs around $50.00 on average across the country.
Refraction tests may be a routine part of your annual vision check. These exams are not expensive on their own, but they are important for maintaining healthy eyes and getting the right prescription lenses for great vision.