Does Medicare Cover an Annual Eye Exam?
Get clear answers on Medicare eye exam coverage. Learn what Original Medicare includes, how Medicare Advantage differs, and key cost considerations.
Medicare, the federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease, provides coverage for a wide range of medical services. Many wonder about its coverage for routine services like annual eye exams. Original Medicare, comprising Part A (hospital insurance) and Part B (medical insurance), generally does not cover routine eye exams for vision correction. Understanding the distinction between routine and medically necessary care is important for your benefits.
Original Medicare and Routine Eye Exams
Original Medicare Part B excludes coverage for routine eye exams. A routine eye exam is conducted to check vision, update prescriptions, or perform general check-ups without a specific medical complaint. If you simply need your vision checked or prescription updated, you will be responsible for the full cost.
This exclusion stems from Medicare’s original design, which focused on medical treatment rather than routine vision correction or preventive care unrelated to a diagnosed medical condition. While a simple vision test might be included during your “Welcome to Medicare” preventive visit, this is distinct from a comprehensive routine eye exam. Individuals relying solely on Original Medicare often pay out-of-pocket for these services.
Original Medicare and Medically Necessary Eye Care
Original Medicare Part B covers eye care when it is medically necessary to diagnose or treat an illness or injury. This includes services for specific eye conditions such as glaucoma, cataracts, diabetic retinopathy, and age-related macular degeneration. If you experience vision problems that suggest a serious eye condition, Medicare will cover the necessary exams, even if the diagnosis turns out to be negative.
For individuals with diabetes, Part B covers an annual eye exam for diabetic retinopathy, a condition where high blood sugar damages eye blood vessels. A glaucoma test is covered once every 12 months for those at high risk, including individuals with diabetes, a family history of glaucoma, or certain ethnic backgrounds and ages. Medicare Part B also covers medically necessary cataract surgery, including removal of the cloudy lens and replacement with an intraocular lens. Following cataract surgery, Part B also covers one pair of corrective lenses, either eyeglasses or contact lenses.
Medicare Advantage Plans and Eye Care
Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits, often including additional coverage not found in Original Medicare. These plans are provided by private insurance companies approved by Medicare and must cover all services Original Medicare (Parts A and B) covers. Many Medicare Advantage plans go beyond Original Medicare by including benefits for routine eye exams, vision correction, and sometimes an allowance for eyeglasses or contact lenses.
Specific vision benefits, including frequency of routine exams or eyewear allowance, vary significantly among Medicare Advantage plans. These plans may also have different provider networks; verify your preferred eye doctor is in-network to ensure coverage. While most Medicare Advantage plans include vision coverage, some offer more comprehensive benefits than others, so beneficiaries should review plan details carefully.
Costs for Medicare-Covered Eye Services
For eye services covered under Original Medicare Part B, beneficiaries are responsible for out-of-pocket costs. After meeting the annual Part B deductible ($257 in 2025), you pay 20% of the Medicare-approved amount for most services. This 20% coinsurance applies to medically necessary eye exams, diagnostic tests, and surgical procedures for conditions like cataracts or glaucoma. There is no annual limit on this 20% coinsurance under Original Medicare.
Costs for eye care under Medicare Advantage plans differ. While many plans cover routine vision benefits, they may involve specific copayments or deductibles for these services. A plan might require a fixed copay for a routine eye exam or a specific allowance for eyewear, with the beneficiary paying any amount exceeding that allowance. In addition to potential copayments, most Medicare Advantage enrollees also pay the standard Medicare Part B premium ($185 per month in 2025), unless the plan offers a premium reduction.