Does Medicare Cover Eye Exams?
- While Medicare Parts A and B don't cover routine eye exams vision care, many Medicare Advantage (Part C) plans may offer vision benefits to include routine eye exams, glasses and contacts.
Medicare is a valuable resource for over 60 million older adults, who depend on the program for most of their medical insurance coverage.
As broad as Medicare’s coverage can be, many seniors’ medical needs go beyond what Medicare can provide. In many cases, such as routine vision and eye care, Medicare beneficiaries may have heard there is no coverage available for eyeglasses or contact lenses, vision testing or cataract surgery.
While it is true that Original Medicare (Part A and Part B) not expressly cover vision care, most Medicare enrollees do have some options available to help pay for needed eye exams and care. One option is enrolling in a privately-sold Medicare Advantage (Medicare Part C) plan.
What Does Medicare Pay For?
Most Medicare beneficiaries are enrolled in the Original Medicare program, which consists of Medicare Part A and Part B.
Part A is the hospital inpatient benefit that pays most of the cost for enrollees’ inpatient hospital stays. Part B is the outpatient services plan that pays for most medical office visits and some home services, medical supplies and other medically necessary outpatient treatments.
Does Medicare Cover Eye Exams?
None of Original Medicare’s parts include coverage for routine vision services. Original Medicare also does not normally pay for routine dental care, alternative therapies such as acupuncture and various other forms of care.
For most Medicare enrollees, 100% of the cost of routine vision services must be paid out of pocket. The good news is, Medicare may help out with vision costs under three possible conditions.
Original Medicare Part B Services
Seniors enrolled in Medicare Part B are not directly covered for routine eye exams, but Medicare Part B does pay for the cost of glaucoma screenings. This typically includes an eye exam, and so it is likely to uncover other, non-glaucoma conditions that can affect vision, such as astigmatism.
Medicare Part B beneficiaries are entitled to one free glaucoma screening a year if their doctor has diagnosed them as being at an elevated risk of the condition.
High-risk individuals typically include:
- Those with a family history of glaucoma
- Beneficiaries who have diabetes
- African-American beneficiaries over age 50
- Hispanic or Mestizo beneficiaries over age 65
Part B beneficiaries may also qualify for an annual vision screening to check for diabetic retinopathy, provided they are:
- Enrolled in Part B
- Willing to schedule the exam with an optometrist in their own state
Finally, Medicare Part B also authorizes annual exams to check for macular degeneration, which is the most common cause of vision loss for American seniors over age 50. If the condition is diagnosed, then Medicare Part B pays 80% of the cost of treatment, such as certain IV drugs administered in an outpatient clinic, after a beneficiary meets their annual Part B deductible.
Does Medicare Pay for Glasses and Contact Lenses?
Original Medicare does not routinely pay any share of the cost for glasses, lenses, frames or contacts. Medicare enrollees who need exam services, fittings and prescriptions for glasses or contacts filled are technically 100% responsible for their own costs.
Part B does, however, offer assistance for beneficiaries who have had cataract surgery.
If an intraocular lens is inserted during this procedure, then Part B can help pay for corrective lenses after surgery. Beneficiaries may order a single pair of glasses through an authorized provider, and extra features are not paid for. Extra features include lens tinting and blending, ultralight and unbreakable frames, light-sensitive tint and other optional add-ons. Medicare enrollees must pay 100% of the cost of optional upgrades.
Unlike the other screening and treatment services, all Medicare Part B enrollees are covered for cataract-related treatments, including screenings and surgery. As with all Part B benefits, Medicare enrollees must pay their annual deductible, which in 2020 is $198 for the year, and then typically 20% of remaining costs for all services Part B covers.
Original Medicare Eye Services for Non-Vision Care
Original Medicare can also help seniors pay for some non-vision eye care. Part B beneficiaries who have lost an eye, for example, are covered for 80% of the cost of a prosthetic replacement. This artificial eye may be polished and resurfaced as needed, with a replacement authorized once every five years.
Other Medicare Options
Part B has many benefits for beneficiaries who need eye services, but it is not the only option for Medicare-eligible seniors. Some older adults with Medicare may get full or partial coverage for routine vision care if they are enrolled in a Medicare Advantage (Medicare Part C) plan that includes vision coverage.
Medicare Advantage With Vision Care
Medicare Advantage plans combine all the benefits of Original Medicare Parts A and B, and they are free to offer extra services as part of the same package.
Part C plans are offered by private insurance carriers, and they entirely replace beneficiaries’ Original Medicare plans and cannot be combined with a Medicare Supplement (Medigap) plan.
Seniors can shop around for a Medicare Advantage plan that offers vision coverage and speak with a plan representative about covered benefits. Medicare Advantage plans that include routine vision coverage may include an allowance for eyeglasses or contact lenses, as well as an annual vision exam.