Does Medicare Cover Eye Exams? 2024

Which Eye Exams Does Medicare Cover?

In general, Original Medicare doesn’t cover routine eye exams for eyeglasses or contact lenses; however, there are some exceptions to this rule because Medicare can provide coverage for eye exams and vision care if an individual has diabetes, glaucoma, macular degeneration, or has undergone cataract surgery.

Diabetes-Related Eye Exams

If you have diabetes, Part B may cover diabetes-related eye exams. This covers medically necessary services and picks up 80 percent of the cost of eye exams for diabetic retinopathy once every year. You’ll pay 20 percent of the Medicare-approved amount, including the deductible or any copayments in a hospital outpatient setting.

Glaucoma Eye Exams

Under Medicare Part B, you can receive up to 80 percent coverage for glaucoma eye exams if you’re at high risk for glaucoma, an eye disease that can cause blindness. A state-certified eye doctor must conduct or supervise the screening.

Medicare Part B covers glaucoma eye exams every 12 months if you’re considered high-risk for diabetes or if you have a family history of glaucoma.

Macular Degeneration

Medicare Part B covers certain diagnostic tests, including: the treatment of eye diseases; certain injected drugs; and various other conditions for patients with age-related macular degeneration.

Cataract Surgery

Medicare Part B can help pay for corrective lenses if a patient has cataract surgery to implant an intraocular lens. This coverage includes corrective lenses with one pair of eyeglasses with standard frames or one set of contact lenses. You’d pay 20 percent of the Medicare-approved amount.

What Parts of Medicare Cover Eye Exams?

Although Original Medicare doesn’t cover eye exams, other parts of Medicare may be able to help pick up the cost for medically necessary services for vision conditions related to diabetes, glaucoma or macular degeneration.

Medicare Part A

Medicare Part A (hospital insurance) doesn’t cover routine eye exams for eye glasses and contact lenses, so you’d have to pay 100 percent of the cost. However, Medicare Part A can cover medically necessary vision care under the specific condition that the patient has a vision problem or experienced a traumatic injury or other type of emergency that required hospitalization.

Medicare Part B

Medicare Part B (medical insurance) doesn’t cover routine eye exams or refractions, so you’d have to pay 100 percent of the costs. In some cases, Medicare Part B can cover 80 percent of the cost of eye exams for diabetic retinopathy once a year if you are diagnosed with diabetes.

The exam must be performed by a state-certified eye doctor, and you’d have to pay 20 percent of the remaining Medicare-approved amount for services and a copayment in a hospital outpatient setting. Additionally, Medicare Part B can cover annual eye exams for individuals with glaucoma and other high-risk patients with diabetes who may be prone to vision problems requiring medically necessary care. Part B can also cover cataract surgery as well as the placement of an artificial lens, along with vision care services such as eyeglasses with standard frames, post-cataract surgery.

Medicare Advantage

Some Medicare Advantage Plans (Part C) may offer additional benefits that are not typically covered by Medicare, such as vision, hearing, or dental. It’s best to contact your Medicare Advantage provider for the most up-to-date information on out-of-pocket costs and coverage. Under Medicare Advantage, you may receive additional benefits such as routine vision care, which includes eyeglasses and contacts.

Medigap/Medicare Supplemental Insurance

Medigap or Medicare Supplemental Insurance is additional insurance that you can purchase from a private insurer. Medigap does not cover routine dental and vision care such as eye exams, eyeglasses, or contacts. However, Medigap will help cover the cost of cataract surgery or other vision conditions. The rule of thumb is, as long as Original Medicare covers it, your Medigap plan will too. However, if Original Medicare doesn’t cover it, your Medigap plan won’t either.

What Do Eye Exams Cost With Medicare?

As mentioned, Medicare generally doesn’t cover routine eye exams, but there are exceptions for high-risk patients.

The average cost of eye exams without insurance ranges between $50-$70. Most insurance policies don’t usually cover routine eye exams and might have additional copays. Since routine eye exams are generally not covered by Medicare, you’d pay 100 percent of their cost.

Eye Exams for Individuals With Glaucoma and Diabetes

If you’re at risk for glaucoma or diabetes, Medicare Part B can cover annual eye exams once every 12 months. For instance, if you use Medicare Part B for glaucoma eye exams, 80 percent of the exam will be covered. However, you’d still be responsible for paying the remaining 20 percent of the Medicare-approved amount after you’ve met your Part B deductible.

Macular Degeneration Exams

Medicare Part B might cover certain diagnostic tests, including the treatment of certain eye diseases and conditions such as age-related macular degeneration, which causes vision loss. You’d be responsible for paying 20 percent of the Medicare-approved amount for these vision services, along with the deductible or any copayments.

Cataract Surgery Eye Exams

Medicare Part B can help pay for corrective lenses if you require cataract surgery to implant an intraocular lens. You’d also receive one pair of eyeglasses with standard frames or one set of contact lenses if it is medically necessary after having undergone cataract surgery.

Does Medicare Cover Vision?

In a nutshell, Original Medicare doesn’t cover routine eye exams. However, under certain circumstances and conditions, Medicare can cover certain types of vision care. For example, Medicare Part B covers medically necessary screenings and eye exams for high-risk individuals with glaucoma, diabetes, or macular degeneration conditions.

Additionally, if you have cataract surgery, Part B can cover medically necessary vision care such as eyeglasses or contact lenses. Medicare can also provide coverage for treatment or surgery for eye conditions such as corneal disease, eye injuries or infections.

Let’s say you have an emergency and you need to be hospitalized for eye surgery. In this case, Medicare Part A can cover the hospitalization and inpatient care after you pay the deductible and 20 percent of the remaining costs. Additionally, Medicare Advantage plans offer additional coverage that Original Medicare may not cover. So, check with your individual Medicare Advantage plan to see whether they provide any vision coverage.

Does Medicare Cover Glasses?

Medicare doesn’t usually cover eyeglasses or contacts, so you’d have to pay 100 percent of the cost — with the exception of certain eye conditions. In some cases, Medicare Part B can help you pay for corrective lenses if you’ve undergone cataract surgery to implant an intraocular lens.

After cataract surgery, you can receive up to one pair of eyeglasses with standard frames or one set of contact lenses. If you’ve had cataract surgery and require eyeglasses and other vision care, you’d still have to pay 20 percent of the Medicare-approved amount and the deductible.

Does Medicare Cover Eye Surgery?

Although Medicare doesn’t cover vision, hearing, or dental procedures, there are certain exceptions. For instance, if you require eye surgery or have a chronic eye condition that puts you at high risk, Medicare can cover cataract surgery or exams for high-risk patients with diabetes.

Medicare can cover cataract surgery with the exception that it’s done using traditional surgical techniques or lasers. Medicare would be able to cover 80 percent of the cost of medically necessary cataract surgery after the deductible is met. Additionally, Medicare Part B can help pay for corrective lenses after you’ve undergone cataract surgery to implant an intraocular lens. If the procedure is deemed medically necessary, the corrective lenses would be covered by Medicare.

Eye Doctors That Accept Medicare

If you’re looking for an eye doctor that accepts Medicare, visit Medicare’s official website and click on the “Find Care Providers” link and use the lookup tool to search for keywords, providers, specialty, and location.

If you’re looking to check whether your Medicare covers certain medically necessary procedures or exams, the best place to check is with Medicare and your provider or corresponding Medicare plan. Some important factors to keep in mind include out-of-pocket costs, deductibles, and other additional costs that are not covered by Medicare.