December 20th 2023
By Ari Parker
Get the facts about Medicare coverage of eye exams with this helpful guide. Learn under what circumstances Medicare covers eye exams and more.
Maintaining good eye health depends on regular checkups, especially after age 65 when eye conditions become more common.
But does Medicare cover vision services?
Many people are surprised to learn that Original Medicare (Part A and Part B) does not cover eye exams for eyeglasses and contact lenses—even with a Medicare Supplement (Medigap) plan.
However, you have other options. Medicare Advantage plans typically cover routine eye exams, Original Medicare covers exams for specific conditions, Medicare Part D helps with prescription eye medications, and Medicaid may cover vision care with prior approval.
In this guide, we’ll dive into which health conditions may get you eye exam coverage with Original Medicare and how you may be able to save money on eye exams and other eye care services.
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.
A routine eye exam does more than check your vision. During your visit, healthcare providers examine your retina and optic nerve to spot potential eye conditions early. They can detect serious issues like macular degeneration and glaucoma before you notice symptoms.
Regular eye exams can also reveal signs of other health issues through your eye's blood vessels, including diabetes and high blood pressure. If your doctor spots concerning changes, they may recommend following up with your primary care provider.
Original Medicare (which consists of Medicare Part A and Part B) does not have basic vision coverage, which means it won't pay for routine vision exams, glasses, or contact lenses.
However, Medicare Part B covers eye exams and treatments when they're needed for specific medical conditions, including diabetes and macular degeneration.
Eye doctors often discover diabetes during routine exams by spotting damaged blood vessels in the retina. This damage can lead to several serious conditions, including glaucoma and cataracts.
The most common diabetes-related eye problem is diabetic retinopathy, which can cause vision loss or blindness if left untreated. An estimated 26% of those with diabetes develop diabetic retinopathy, and more than 5% of them go blind, according to recent research.
Medicare covers yearly eye exams for people with diabetes to catch these problems early. Learn more about other Medicare-covered services for diabetics here.
Macular degeneration is a common eye condition that affects central vision in people over 60. Also known as age-related macular degeneration (AMD or ARMD), it can make daily activities, like reading and driving, difficult. While there's no cure, early detection and treatment can help manage symptoms.
Medicare covers macular degeneration exams and treatments when recommended by your doctor.
Glaucoma occurs when pressure builds up in your eye, which can lead to vision loss if not treated early. Annual eye exams check for this pressure, and early detection is key.
Medicare covers a glaucoma screening once every year if you're at high risk. You qualify for coverage if you meet any of these conditions:
You have diabetes or a family history of glaucoma
You're African American and aged 50 or older
You're Hispanic and aged 65 or older
Cataracts are an eye disease that clouds your vision. The most common treatment is cataract surgery, which replaces your natural lens with an artificial one called an intraocular lens (IOL). These intraocular lenses offer the chance for vision correction and clarity, though you may still need glasses afterward.
Medicare helps cover the cost of exams, surgery, and post-surgery care for cataracts.
If Original Medicare covers your eye exam, you'll pay for a portion of the cost. Medicare Part B covers 80% of the cost if you’ve met your Part B deductible. You’re responsible for paying the remaining 20% (this is your coinsurance). A Medicare Supplement plan will reduce your out-of-pocket costs.
Remember: Medicare typically won't pay for corrective lenses or the exam to prescribe them. Before you get your eye exam, make sure you understand your coverage and costs.
Unlike Original Medicare, Medicare Advantage (Part C) plans often cover routine eye exams, eyeglasses, and contact lenses.
However, coverage varies between plans. Carefully check your Medicare Advantage plan's details to understand which eye care services are covered, what your plan will pay, and how much you’ll owe out of pocket.
If you're new to Medicare, make sure to get your free Welcome to Medicare checkup. This checkup includes a basic vision test and is an option during your first 12 months with Part B coverage.
While Medicare may not cover routine eye exams, eyeglasses, or contact lenses, there are some additional ways to manage your eye care costs.
Many retail stores (like Sears, Walmart, Lenscrafters, and Costco) offer affordable eye exams with licensed optometrists. If these exams uncover any eye condition needing specialized care, your eye doctor can refer you to the right specialist, and Medicare may cover your care.
If your Medicare plan doesn't include vision coverage and you’re unable to afford services from select retailers with cheaper options, several programs can help.
EyeCare America offers free eyecare if you're over 65, have glaucoma or are at high risk, haven't seen an eye doctor in three years, and don't have HMO or VA eye care benefits.
Local organizations like Lions Clubs offer free eye exams in many areas.
Veterans may qualify for free eye doctor visits and glasses through the VA.
Make sure to compare 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.
You can consult with your primary care physician or pharmacist about low-cost options for eyewear near you.
Many organizations like AARP and AAA offer vision care discounts if your health insurance doesn't include coverage. Watch for sales at retailers like Lenscrafters and America’s Best, which often provide significant savings on glasses and eye exams.
Many people on Medicare choose to enroll in Medicare Advantage plans to get vision and dental coverage. But choosing a Medicare Advantage plan to get vision coverage requires careful consideration because Medicare Advantage plans also have their disadvantages. Make sure you don’t sacrifice your healthcare needs to save a little on your vision care. During the annual Open Enrollment Period, a licensed insurance agent can help you compare all of your Medicare coverage options to find the medical insurance that fits your needs.
Have more questions about what Medicare does and doesn’t cover? Speak to one of our independent Medicare 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.
