Does Medicare Cover Eye Exams?
This article was updated on: 09/10/2018
Routine eye and vision exams can be an important part of your overall health care. Original Medicare (Part A and Part B) usually doesn’t cover eye exams except in certain cases as described below. This summary of your Medicare benefits will help you understand your coverage.
When might Medicare cover eye exams?
While Original Medicare doesn’t generally cover routine eye care, there are a few instances when your Part B coverage may help offset your eye exam costs:
- If you are considered to be at high risk for glaucoma (if you have diabetes, a family history of glaucoma, or are African American and over age 50, for example), Part B may cover 80% of allowable costs if your doctor believes the test is medically necessary.
- If you have diabetes, Part B may cover 80% of your eye exam cost to check for diabetic retinopathy.
- Certain people with age-related macular degeneration may qualify for Part B coverage of eye exams and treatment, including injectable medications, for the disease.
- If your eye gets injured, Original Medicare may cover medically necessary diagnostic eye exams and treatment.
You must get care from a provider who accepts Medicare assignment in order to be covered. You’ll generally also pay 20% of allowable charges plus any applicable Part B deductible.
Does Medicare cover routine eye exam costs?
Except in the circumstances noted above, there is generally no Part B coverage for routine eye exams and vision checks. If you wear prescription eyewear or contact lenses, these costs are also not included in your Part B benefits, except in certain medical situations. For example, if you have cataracts and undergo surgery for treatment, Part B may cover one pair of prescription eyeglasses or contact lenses after the procedure. Your Part B coinsurance and deductible applies.
Are there other options to get Medicare coverage for eye exam costs?
You may be able to enroll in a Medicare Advantage plan that offers coverage for routine eye exam costs and even prescription eyewear. The Medicare Advantage program is an alternative way to get your Original Medicare benefits. These plans must provide the same coverage as Part A and Part B (except for hospice care, which is still covered under Part A).
Many Medicare Advantage plans include coverage for prescription drugs, as well as other benefits to help you manage your health-care costs, such as:
- Benefits for routine vision care, including an annual eye exam and prescription eyewear
- Coverage for routine hearing care
- Optional dental care coverage for routine exams, cleanings, and even restorations and dentures
- Benefits for wellness programs and discounted gym memberships
Not all Medicare Advantage plans have all these optional benefits and coverage, and not all plans may be available in all areas. You must continue to pay your Part B premium, plus any additional premium required by your plan, and premiums may vary depending on the plan you choose and where you live. You will also be responsible for any copayments, coinsurance amounts, or deductibles required by your plan.
Some Medicare Advantage plans require you to get your care from providers in the plan’s network, or offer you significant savings if you choose the plan’s preferred providers. If you enroll in a Medicare Advantage plan, you still have all the same rights and protections you get with Original Medicare, and you can still return to Original Medicare during the Medicare disenrollment period between January 1 and February 14 of every year.
If you have questions about Medicare coverage for eye exams, or Medicare Advantage benefits to offset your eye exam costs, I’m happy to help you. Request an email or schedule a telephone call by using one of the links at the bottom of the page. To see a list of plans in your area you may qualify for, click the “Compare Plans” button on this page.