Does Medicare cover eye exams and vision care?

Original Medicare (Part A and Part B) doesn’t cover eye exams or other vision-related costs, except for special situations. However, some people on Medicare have options, including vision coverage through individual insurance or Medicare Advantage plans (Part C) with vision coverage.

Let’s look into the details of Medicare, eye exams and vision care.

Does Medicare cover vision?

No, Original Medicare doesn’t include coverage for routine vision services. In some cases, Medicare might cover certain vision-related items or services if an illness or injury resulted in eye problems. Original Medicare may also cover medically necessary treatments that may improve or cure chronic eye conditions like glaucoma or cataracts.

Does Medicare cover eye exams?

No, Original Medicare doesn’t cover routine eye exams, also called “eye refractions,” for eyeglasses or contact lenses. However, a simple vision test is included in your “Welcome to Medicare” preventive visit. The visit is covered by Medicare Part B and offered only once within the first year of enrolling in Part B.1

If you have or are at risk for certain eye conditions, Original Medicare may help cover certain tests and treatment. Some examples include:

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Diabetic eye exams

Medicare Part B helps cover a yearly diabetic eye exam for people living with diabetes and diabetic retinopathy. To get coverage, the exam must be given by an eye doctor who’s legally allowed to do the test in your state.

You pay 20% of the Medicare-approved amount for diabetic eye exams after you meet the Part B deductible. If the exam is done in a hospital outpatient setting, you also pay a copayment.2

Glaucoma testing

Part B helps cover a glaucoma test every 12 months if you’re at high risk for developing this eye disease. To be considered high risk, you must have at least 1 of these conditions:

  • Diabetes
  • A family history of glaucoma
  • You’re African American and age 50 or older
  • You’re Hispanic and age 65 or older

You pay 20% of the Medicare-approved amount for glaucoma testing after you meet the Part B deductible. If the exam is done in a hospital outpatient setting, you also pay a copayment.3

Macular degeneration testing

Part B may help cover some tests and treatment of eye diseases and conditions if you have age-related macular degeneration.

You pay 20% of the Medicare-approved amount for macular degeneration testing after you meet the Part B deductible. If the exam is done in a hospital outpatient setting, you also pay a copayment.4

Does Medicare cover eyeglasses?

No, Medicare usually doesn’t cover the cost of eyeglasses or contact lenses. But if you need cataract surgery—and an intraocular lens (IOL) is implanted—Part B will help cover the cost of 1 set of corrective lenses.

You pay 20% of the Medicare-approved amount for corrective lenses (1 pair of eyeglasses with standard frames or 1 set of contact lenses) after you meet the Part B deductible.5

Frequently asked questions

Does Medicare cover the cost of cataract surgery?

Yes, Part B will help cover cataract surgery if it’s medically necessary and done using traditional surgical techniques or lasers. You pay 20% of the Part B copay plus any out-of-pocket costs such as your deductible, medication costs and physician fees.6

Do Medicare Advantage plans provide vision coverage?

Yes, some Medicare Advantage plans could help cover routine vision care and prescription eyewear. The coverage options and costs can vary from plan to plan and may not be available in all areas.

Many of Humana’s Medicare Advantage plans provide coverage for routine vision care. Humana Medicare Advantage vision coverage may include annual exams, eyeglass frames with prescription lenses and prescription contact lenses.

How can I save money on vision care?

Even with Original Medicare or Medicare Advantage, you may still owe out-of-pocket costs for vision services and equipment. Here are some potential ways to potentially save on vision care:

  • See if your regular doctor can refer you to low-cost eye care nearby
  • If you have an eye doctor, ask if there are discount programs available for you
  • Ask your pharmacist if they offer discounts on medicines or medicine delivery

For more answers on Medicare coverage, check out what does Medicare cover (and not cover)?

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Sources

  1. “Eye exams (routine),” Medicare.gov, last accessed May 3, 2023, https://www.medicare.gov/coverage/eye-exams-routine.
  2. “Eye exams (for diabetes),” Medicare.gov, last accessed May 3, 2023, https://www.medicare.gov/coverage/eye-exams-for-diabetes.
  3. “Glaucoma tests,” Medicare.gov, last accessed May 3, 2023, https://www.medicare.gov/coverage/glaucoma-tests.
  4. “Macular degeneration tests & treatment,” Medicare.gov, last accessed May 3, 2023, https://www.medicare.gov/coverage/macular-degeneration-tests-treatment.
  5. “Eyeglasses & contact lenses,” Medicare.gov, last accessed May 3, 2023, https://www.medicare.gov/coverage/eyeglasses-contact-lenses.
  6. “Eyeglasses & contact lenses.”