Does Medicare Cover Eye Doctor Visits?
Understand Medicare's coverage for eye doctor visits. Learn what's covered, what's not, and how different plans affect your vision care costs.
Medicare is a federal health insurance program for Americans aged 65 or older and certain younger individuals with disabilities. Coverage depends on the nature of the eye service, as Medicare primarily focuses on medically necessary care.
Original Medicare Coverage for Eye Care
Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), provides coverage for medically necessary eye care services. Part B covers outpatient services for diagnosing and treating eye diseases, conditions, or injuries. This includes specific conditions like cataracts, where it covers surgery and related services, including the placement of a conventional intraocular lens.
For glaucoma, Original Medicare Part B covers diagnostic tests and treatment, including annual screenings for individuals at high risk. People with diabetes are eligible for a yearly eye exam to check for diabetic retinopathy, a condition that can result from diabetes. Additionally, certain diagnostic tests and treatments, such as specific injected drugs, for age-related macular degeneration (AMD) are covered under Part B. If an eye condition requires an inpatient hospital stay, Medicare Part A may cover the hospital costs.
Items Not Covered by Original Medicare
Original Medicare does not cover routine vision care services or items, such as regular eye exams for checking vision or prescribing eyeglasses. The program considers these services to be routine or elective vision care rather than medically necessary treatments for disease or injury.
Items such as eyeglasses, contact lenses, and the fitting services for these corrective lenses are also not covered under Original Medicare. An exception exists for corrective lenses following cataract surgery, where Original Medicare Part B may cover one pair of eyeglasses with standard frames or one set of contact lenses after the procedure. Aside from this specific scenario, beneficiaries are responsible for the full cost of routine vision correction.
Medicare Advantage Plans and Eye Care
Medicare Advantage Plans, also known as Part C, are offered by private companies approved by Medicare and operate as an alternative to Original Medicare. These plans are required to cover everything Original Medicare covers, but they often provide additional benefits. Many Medicare Advantage plans include coverage for routine eye exams, eyeglasses, and contact lenses, which are not covered by Original Medicare.
The specific scope of vision coverage under Medicare Advantage plans can vary significantly from one plan to another. For instance, plans may limit the frequency of routine eye exams, often to once per year, and may impose caps on the amount they will pay for eyeglasses or contact lenses. Enrollees should carefully review their plan’s benefits to understand the extent of coverage. These plans may also utilize networks of providers, requiring beneficiaries to see eye care professionals within the plan’s network for covered services.
Out-of-Pocket Costs
For services covered by Original Medicare, beneficiaries face a Part B deductible, which is $257 in 2025. After meeting this deductible, beneficiaries are responsible for 20% of the Medicare-approved amount for medically necessary eye services. There is no annual limit on this 20% coinsurance.
If an eye condition necessitates an inpatient hospital stay, the Medicare Part A deductible applies, which is $1,676 per benefit period in 2025. For Medicare Advantage plans, out-of-pocket costs vary based on the specific plan chosen. These plans may have their own deductibles, copayments for routine eye exams, or allowances for eyewear. While many Medicare Advantage plans offer affordable premiums, they often involve specific copays for services or limits on eyewear allowances, meaning beneficiaries may still incur costs.