Good eye health and vision are important parts of taking care of your well-being. For some health conditions, like diabetes, eye issues are often a result of another underlying condition. 

While Original Medicare (Part A and Part B) does not cover routine eye exams for eyeglasses and contact lenses, it does cover treatment for specific eye conditions and diseases. Medicare Advantage plans often include coverage for routine eye exams. 

In this guide, we’ll dive into what health conditions get you eye exam coverage with Original Medicare and how you may be able to save money on eye care.

Key takeaways:

  • Original Medicare does not cover routine eye exams.

  • Medicare Advantage plans often include coverage for eye exams.

  • Medicare does cover specific medical conditions affecting the eyes.

 What are eye exams for?

Eye exams assess the overall health of your eyes and detect any vision issues you may have. During a routine eye exam, medical professionals evaluate how good your vision is, check if you have issues with seeing near or far distances, and examine the health of your retina and optic nerve. Your eyes can also show symptoms for conditions like diabetes, macular degeneration, glaucoma, and cataracts. Eye exams are essential for detecting these conditions early on.

Which eye exams does Medicare cover?

Original Medicare does not have basic vision coverage, and it doesn’t cover routine vision exams for glasses or contact lenses. Original Medicare does, however, cover vision-related services if you have an injury or certain medical conditions that cause issues with your eyes.

Medicare Part B will cover the costs of any tests and treatments related to eye problems like:

Diabetic eye tests: For those that have diabetes and diabetic retinopathy, Medicare helps pay for a yearly diabetic eye exam. Learn more about other Medicare-covered services for diabetics.

Macular degeneration exams: If you develop macular degeneration, an age-related disease that worsens a person’s eyesight, a macular degeneration exam and necessary treatment are covered.

Glaucoma testing: If you’re at high-risk for developing glaucoma, Medicare helps pay for a glaucoma screening once every year. To be considered “high-risk” and get coverage, you’ll have to at least meet one of these conditions:

  • You have diabetes

  • You have a family history of diabetes

  • You’re African American and 50 years or older 

  • You’re Hispanic and 65 years or older

Eye exams for cataracts: Medicare helps cover the cost of exams, surgery, and post-surgery care for cataracts if it is medically necessary. 

While Original Medicare covers eligible eye exams, note that beneficiaries may still incur some out-of-pocket expenses. Typically, Medicare Part B covers 80% of the Medicare-approved amount for exams and treatment, leaving you responsible for the remaining 20%. A Medicare Supplement plan can help offset these out-of-pocket costs.

Medicare Advantage coverage for eye exams 

Medicare Advantage (Part C) is an alternative to Original Medicare provided by private companies. These plans often include vision, dental, and hearing coverage.

Medicare Advantage plans often help pay for routine eye exams, prescription eyeglasses, and contact lenses as part of their benefits. However, coverage varies between plans, and you should carefully review the details of your specific Medicare Advantage plan to understand exactly what you’ll pay for eye care services.

Other considerations for Medicare and eye care

Despite the limitations in coverage for routine eye exams, there are a few ways you can save money on eyeglasses or contact lenses.

Research comparison for eyewear: Comparing costs for eyeglasses and contact lenses at various providers, including online retailers, like Warby Parker. Shopping around can help you find the best deals and a price that works for you.

Ask a provider: You can consult with your primary care physician or pharmacist about low-cost options for eyewear near you.

Have questions more about what Medicare does and doesn’t cover? Speak to one of our independent Advisors, eager to help you with understanding the intricacies of your plan and how to get the most out of Medicare. Get in touch by calling us at (855) 900-2427 or picking a time to chat.

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