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does medicare cover prosthetic eyes

Does Medicare Cover Prosthetic Eyes?

Prosthetic eyes provide comfort to those who have lost an eye due to disease, injury or facial malformation.

For those who need a prosthetic eye, the cost is a big consideration. Because of this, a common question many people have is, “does Medicare cover prosthetic eyes?”

In this article, we answer the question in clear, plain English. You will also find the average costs of prosthetic eyes, as well as other helpful info.

Does Medicare Cover Prosthetic Eyes?

The short answer is yes; Medicare will cover the cost of prosthetic eyes. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your prosthetic eyes. Below we look at what these are so you know what to expect.

Medicare Part B provides coverage for prosthetics. And prosthetic eyes included in that category. However, they will only cover them if it is medically necessary. This often means they are needed due to an injury or surgical procedure.

To get coverage, you will need an order from a doctor. Also, you will have to get the eye through a supplier enrolled in the Medicare program.

If the above conditions are met then Medicare Part B will cover 80% of the costs for the prosthetic eyes.

Medicare Part A may cover hospital fees if you require a surgically implanted prosthetic eye. This is only if the surgery takes place in an inpatient setting or hospital.  

Medicare Advantage Plans or Medicare Part C also cover prosthetics as long as they are medically necessary. Coverage for these plans vary so you’ll want to check with your plan provider to find out exactly what they’ll cover.

How Much Do Prosthetic Eyes Cost?

Prosthetic eyes, along with the implant, costs between $2,500 to $8,300. However those costs do not include surgery involved in the procedure.

What Is A Prosthetic Eye?

Prosthetic eyes are a treatment option to replace the eye(s) that a person lost or has to be removed. This could be due to disease, a traumatic eye injury or facial malformation. They are suitable to all people regardless of age and gender.

One thing to be clear of is that prosthetic eyes do not restore a person’s lost vision. What it does is to provide comfort to our eyeless socket and a balanced facial appearance.

Prosthetic eyes have been around for millennia, and early prosthetic eyes were made out of painted clay that was attached to a piece of cloth.

Then glass was used to make them (which sounds much better than clay and cloth!). But glass isn’t used much anymore.

Today, prosthetic eyes are a spongy, porous round implant that is inserted in the eye socket. The insert is covered with an eye tissue called the conjunctiva.

To make it look like an authentic eye, these prosthetics are thin and curved. They look glossy because they use acrylic for paint. These implants look very natural.

You can find ready-made prosthetic eyes available on the market today. Or, you can get a custom-fitted one for a better fit to match with your other eye.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover support stockings?

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