Does Medicare Cover Eye Exams?
Key Takeaways
- Original Medicare Parts A and BOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). don’t cover routine eye exams for contacts or eyeglasses.
- Most Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans include vision coverage for routine care like eye exams for contacts and eyeglasses.
Original Medicare typically doesn’t cover eye exams. While Original Medicare does not cover those services, nearly all Medicare Advantage plans provide some level of coverage that can help pay for your vision-related needs.
Your Ideal Medicare Plan is out there.
Let’s Find It Together
Does Medicare Cover Vision?
The expenses related to routine eye care are typically not covered by Part A or Part B, leaving you responsible for the costs. If you need eye exams regularly, Medicare Advantage or a standalone vision insurance plan from a private insurance company may be able to help.
Medicare vision coverage is minimal. Original Medicare typically doesn’t pay for routine exams or eye procedures or corrective lenses in the form of eyeglasses or contact lenses. One of the few exceptions relates to cataracts.
Does Medicare Cover Cataracts?
A cataract is the clouding of the eye’s natural lens that commonly affects people as they grow older. Original Medicare Part B does cover medically necessary cataract surgery.
Original Medicare also covers eyeglasses after cataract surgery. Part B will pay for one corrective vision device (pair of eyeglasses or contacts) after an intraocular lens is surgically inserted to replace the eye’s natural lens.
You are still required to pay the standard 20% coinsurance for cataract-related services if you haven’t met your deductible.
Similarly, Part B covers some tests and treatments related to age-related macular degeneration, an eye disease characterized by the central part of the retina’s degeneration.
Does Medicare Pay for Eye Exams?
While Original Medicare doesn’t pay for most eye exams, it does pay for an eye exam for diabetes patients. Original Medicare will cover — minus the standard 20% copayment — a test for diabetic retinopathy, which is a condition that can cause vision loss and even blindness in diabetes patients.
Medicare Part B also pays 80% of the glaucoma test costs for people considered at high risk. Note: glaucoma tests are a common part of a routine eye exam, but Medicare Part B won’t pay for anything beyond the glaucoma test itself.
You qualify for a covered glaucoma test if:
- You have diabetes.
- You have a family history of glaucoma.
- You’re African American and age 50 or older.
- You’re Hispanic and age 65 or older.
How Often Does Medicare Pay for Eye Tests?
Original Medicare covers testing once every 12 months. Medicare does not pay for eye exams in between the yearly allowance.
Find the Medicare Plan that works for you.
Find My Ideal Plan
Does Medicare Cover Lasik or Lasik Eye Surgery?
LASIK (Laser-Assisted in Situ Keratomileusis) is a popular procedure that changes the cornea’s shape to improve vision. Original Medicare does not cover an elective procedure. LASIK often isn’t covered by Medicare Advantage or by standalone vision insurance, but be sure to check before enrolling in a plan.
Some cataract surgeries are laser-assisted, and those are covered by Original Medicare when medically necessary.
Are Eye Exams Covered Under Medicare?
While routine eye exams usually aren’t covered by Original Medicare, they often are covered by Medicare Advantage. GoHealth has licensed insurance agents just a phone call away who can discuss Medicare Advantage plans that offer vision coverage and review the details of specific plans with you.
If you are enrolled in both Part A and Part B of Original Medicare, you are eligible to switch to Medicare Advantage (Part C), which offers the same Part A and B benefits while often bundling additional services like dental, hearing, and vision.
Does Medicare Pay for Glasses?
If you have Original Medicare, the answer is “rarely” unless you undergo cataract surgery. However, many Medicare Advantage plans help cover the costs of glasses.
Medicare Advantage Plans With Dental and Vision
Vision coverage is just one example of options offered by many Medicare Advantage plans. Unlike Original Medicare, many Medicare Advantage plans cover vision, dental, and hearing, and some plans also provide a yearly stipend that can be used to purchase personal items like vitamins and toothpaste.
If you’re on Original Medicare and require or desire additional services, contact GoHealth to review your options.
Have questions about your Medicare coverage?
Call Today
Sources
- Eyeglasses Coverage. medicare.gov.
- Macular Degeneration Coverage. medicare.gov.
- Diabetic Eye Exam Coverage. medicare.gov.
- Glaucoma Test Coverage. medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.