Does Medicare Cover Eye Exams?
Key Takeaways
- Original Medicare (Parts A and B)Original 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). doesn’t cover routine eye exams unless you have a qualifying health condition.
- People with diabetes, age-related macular degeneration, a high risk for glaucoma, or cataracts may qualify for Medicare-covered eye exams.
- 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 from private insurance carriers may provide additional benefits.
- Other ways to get vision coverage include Medicaid, community health programs, or stand-alone vision insurance.
Original Medicare does not cover routine eye exams for most people. You’ll generally pay for vision exams out of pocket if you don’t have another source of coverage. Learn more about the circumstances when Medicare covers eye exams below.
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What Happens at a Routine Eye Exam?
When you go to the eye doctor, known as an optometrist, they’ll thoroughly check your vision health. During a routine eye exam, the doctor may:
- Ask about your medical and vision history to learn if you might be at risk for any eye conditions.
- Have you read letters on an eye chart to test your vision at different distances.
- Determine your vision prescription.
- Check how well your eyes respond to light and movement.
- Check your peripheral vision.
- Look at the inner structures of your eye to check for cataracts, corneal scratches, macular degeneration, and diabetic retinopathy.
- Test your eye pressure to check for glaucoma.
Why Eye Exams Are Important for Vision Health
Around 11 million Americans over age 12 require some form of vision correction. Regular eye exams ensure you have an up-to-date prescription for corrective lenses.
Skipping out on eye exams means you might miss early detection of common eye diseases. For example, diabetic retinopathy can eventually lead to blindness, but early detection and treatment can prevent or delay blindness in approximately 90% of people.
For older adults, proper eye care is especially important, as many eye conditions are age-related. Staying on top of your eye health can prevent problems down the line.
How Medicare Covers Eye Exams
Original Medicare (Parts A and B) does not cover routine eye exams. However, Medicare does cover eye exams for specific conditions:
- People with diabetes: Medicare covers one annual eye exam to screen for diabetic retinopathy.
- Macular degeneration: Medicare covers diagnostic tests and treatment for age-related macular degeneration.
- Glaucoma screening: Medicare covers one glaucoma screening per year if you’re at high risk for getting the disease. You might be at high risk if one of the following factors apply:
- You have diabetes
- Your family has a history of glaucoma
- You are African American and age 50 or older
- You are Hispanic and age 65 or older
- Cataract care: Medicare covers cataract surgery to replace a cloudy lens in your eye. It might also cover one pair of eyeglasses or contact lenses after your surgery.
These are not the same as a routine eye exam. They only focus on the problem at hand instead of offering a broader analysis of your eye health
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How Medicare Advantage Covers Eye Exams
Medicare Advantage plans, also called Medicare Part C, are offered by private insurance carriers as a substitute for your Part A hospital insurance and Part B medical insurance. Medicare Advantage plans have to follow the same minimum coverage rules as Original Medicare, but many offer additional benefits. For example, Medicare Advantage Prescription Drug plans include Part D prescription drug benefits.
Many Medicare Advantage plans include vision coverage, but details differ by plan. To get the most from your benefits, you may need to see healthcare providers who are in your plan’s network.
How Much Eye Exams Cost With Medicare
If you are eligible for an eye exam through Original Medicare, you’ll use your Medicare Part B insurance. There are three main costs associated with Part B:
- Premium: Your monthly payment to maintain coverage ($185 in 2025).
- Deductible: You’re responsible for paying a portion of your healthcare costs before coverage kicks in for the year. In 2025, the Part B deductible $257.
- Copayment: After you’ve met your deductible, Medicare pays 80% of the approved cost for an exam, so you’ll pay the remaining 20%. For example, if a visit costs $200, Medicare would pay $160 and you’d pay $40.
The costs for covered vision care depend on your Medicare Advantage plan. An annual out-of-pocket maximum limits the total amount of medical costs you pay each year before insurance starts paying for all of your covered services.
If you don’t have any kind of insurance, you’ll have to pay completely out of pocket. Fees for an eye exam can range from $45 to over $200. And you may pay more if you have additional needs, like a fitting for contact lenses.
Other Options For Eye Exam Coverage
- Medicaid: Medicaid is a program that provides health coverage to people with limited income. Every state manages its own Medicaid program, so your eye exam coverage may vary depending on where you live. However, 38 states offer coverage for an exam at least every two years.
- Community health programs: Some local areas have initiatives to help people manage their eye health. If you have a program like that in your area, it may offer free or reduced-cost optometrist visits.
- Private vision insurance: It’s possible to buy a stand-alone vision insurance plan that covers eye exams.
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Putting It All Together
Regular eye exams can protect your eye health and diagnose certain conditions early. However, Original Medicare does not cover routine eye exams. Original Medicare does cover other vision-related benefits, including cataract surgery, an eye exam for diabetic retinopathy, and glaucoma screenings if you meet eligibility criteria.
Sources
- Routine Eye Exam Coverage. Medicare.gov.
- Diabetic Eye Exam Coverage. Medicare.gov.
- Eyeglasses Coverage. Medicare.gov.
- Why Eye Exams Are Important. Centers for Disease Control and Prevention.
- Macular Degeneration Coverage. Medicare.gov.
- Glaucoma Test Coverage. Medicare.gov.
- Medicare Cataract Surgery Coverage | What’s Covered. Medicare.gov.
- 2025 Medicare costs. Medicare.gov
- Medicaid vision coverage for adults varies widely by state. National Eye Institute.
- What You Need to Know: Eye Exam Costs and Financing Options. Vision Center.