Does Medicare Cover Eye Exams?
Key Takeaways
Original Medicare Parts A and B don’t cover routine eye exams for contacts or eyeglasses.
Some but not all Medicare Advantage 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, many Medicare Advantage plans provide some level of coverage that can help pay for your vision-related needs.
Find a local Medicare plan that fits your needs
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. Original Medicare Part B does cover medically necessary cataract surgery. And does Medicare cover eyeglasses after cataract surgery? Yes, Original Medicare pays 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.
What Eye Exam does Medicare pay for?
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 will also pay 80% of the glaucoma test costs for people considered at high risk. (note: glaucoma tests are a common part of a routine eye exam, 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. Does Medicare pay for eye exams in between the yearly allowance for some situations? It does not.
Are you eligible for cost-saving Medicare subsidies?
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 that improves vision like eyeglasses or contact lenses. LASIK often isn’t covered by Medicare Advantage or by standalone vision insurance, but be sure to check whether that’s the case 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, yes, vision.
Does Medicare pay for glasses?
Just as with routine eye exams, some Medicare Advantage plans will pay for glasses.
Does Medicare pay for eyeglasses? It depends on your plan. If you have Original Medicare, the answer is “rarely.” If you have Medicare Advantage, the answer is “maybe,” and because Medicare Advantage offers numerous plans in most areas, you can switch to a plan that makes the answer “yes.”
What extra benefits and savings do you qualify for?
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 coverage, 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.
