Original Medicare (Parts A and B) does not cover routine eye exams, glasses, or contact lenses for refractive errors. However, Part B covers medically necessary services, including annual screenings for diabetic retinopathy and glaucoma for high-risk individuals, as well as cataract surgery. For routine vision care, beneficiaries may enroll in a Medicare Advantage (Part C) plan that includes vision benefits.
Does Original Medicare (Parts A and B) cover routine eye exams?
No. Original Medicare generally does not cover routine eye exams for prescribing glasses or contacts, or general vision screenings. Medicare Part A (also known as hospital insurance) does not cover eye exams or vision care unless the treatment takes place during a hospitalization. For example, if you experience trauma to the eye and go to the hospital, Medicare Part A will likely cover your treatment. However, a regular contact or eyeglasses exam would not be covered.
Which medically necessary vision services are covered by Part B?
Medicare Part B also doesn’t cover routine eye exams, but it does cover some diagnostic and preventative tests. In each case, you’ll typically pay 20% of the approved Medicare cost, plus your Medicare Part B deductible and copay if applicable.
Eye Exams for Diabetic Retinopathy Screening
Because Medicare Part B covers medically necessary services, including some preventive services, it will cover annual eye exams for diabetic retinopathy (a complication that damages the blood vessels in the retina) for people with diabetes.
Annual Glaucoma Testing for High-Risk Individuals
If you’re at high risk for glaucoma, an eye condition that damages the optic nerve, Medicare Part B will cover one screening every 12 months. To be considered high risk, one of the following criteria should apply:
You have diabetes
You have a family history of glaucoma
You’re African American and aged 50 years or older
You’re Hispanic and aged 65 years or older
Cataract Procedures and Post-Operative Eyewear
For cataract surgery performed using traditional surgical techniques or with lasers, Medicare Part B covers the following:
The surgery to remove the cataract (a cloudy lens that impacts your vision)
Intraocular lens implants (clear disks that help your eyes focus)
One set of prescription eyeglasses or one set of contact lenses after the surgery
Diagnosis and Treatment of Other Serious Eye Conditions
Medicare Part B may cover specific diagnostic tests and treatments for people with age-related macular degeneration, an eye disease that blurs or reduces your central vision. It also may cover diagnosis and treatment for eye conditions like pink eye (conjunctivitis) or other trauma when treated in an outpatient setting.
What are your out-of-pocket costs for covered services?
For medically necessary vision services covered by Part B, you’ll typically pay 20% of the Medicare-approved amount after meeting the Part B deductible. What you owe will depend on:
If your doctor accepts Medicare
The type of facility
The location you receive services from
Other insurance you may have
How much your doctor charges
Using a state-authorized provider who accepts Medicare assignment can help make it easier to plan for any out-of-pocket costs you may incur.
Filling the Vision Gap: How Medicare Advantage (Part C) May Provide Routine Coverage
While Original Medicare does not include coverage for routine eye exams, Medicare Advantage plans may offer additional benefits not included in Medicare Parts A and B, such as routine vision coverage.
How to Compare Plans That Offer Routine Vision Benefits
For Medicare Advantage plans that offer routine vision coverage, benefits may include yearly routine eye exams and an allowance for prescription contacts or glasses. Vision coverage will vary by plan and network. An easy way to compare Medicare Advantage plans is to work with SelectQuote. If you’re new to Original Medicare, on Medicare but recently moved, or lost your health insurance, you may be eligible for a free, no-obligation Medicare Advantage plan review with a licensed agent.
The Importance of Proactive Vision Care for Seniors
It’s important for all adults to consider regular vision care, but especially older adults. As you age, your risk of developing conditions that affect your vision (like glaucoma, cataracts, or age-related macular degeneration) increases. Vision problems can increase your fall risk and affect your mental health, negatively impacting your overall well-being and quality of life. However, seeking regular eye care can help you catch vision problems earlier, lessening the severity or helping you avoid them altogether. The American Optometric Association recommends annual eye exams for everyone over age 60.
Have questions about Medicare Advantage coverage? Let SelectQuote help.
If you have questions about Medicare Advantage coverage for routine vision care, we can help. SelectQuote’s experienced licensed insurance agents can quickly and easily review the Medicare Advantage plans available to you, helping you understand costs and benefits. The service is free and there’s no obligation to enroll.
