Does Medicare Cover Vision, Glasses, or Eye Exams?
Does Medicare cover vision? Discover what eye care Original Medicare covers (medical vs. routine) and explore options for comprehensive vision benefits.
Medicare, a federal health insurance program, primarily serves individuals aged 65 or older, younger people with certain disabilities, and those with End-Stage Renal Disease. Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover routine eye care. However, it does provide coverage for eye care deemed medically necessary due to injury or disease.
Original Medicare Vision Benefits
Original Medicare Part B covers eye-related services considered medically necessary to diagnose or treat conditions like glaucoma, cataracts, and diabetic retinopathy. For instance, Medicare Part B covers annual glaucoma screenings for high-risk individuals, such as those with diabetes or a family history of glaucoma. These screenings may include dilated eye exams or intraocular pressure measurements.
Cataract surgery is another significant area of coverage under Medicare Part B when a doctor determines it is medically necessary. This includes the removal of the cataract and the implantation of a basic intraocular lens. Part B also covers one pair of prescription glasses with standard lenses or contact lenses following cataract surgery. The coverage extends to preoperative and postoperative exams related to the surgery.
Medicare Part B also covers diagnostic tests and treatment for age-related macular degeneration (AMD). For individuals diagnosed with diabetes, Medicare Part B provides coverage for one eye exam per year to check for diabetic retinopathy.
For medically necessary services covered under Part B, beneficiaries pay 20% of the Medicare-approved amount after meeting the annual Part B deductible. The Part B deductible is $257 in 2025. Medicare also covers prosthetic eyes under Part B, with coverage for the device itself, necessary modifications, and repairs.
Routine Vision Care and Original Medicare
Original Medicare, which includes Parts A and B, does not cover routine vision care services. This means that standard eye exams performed solely to check vision or to determine a prescription for glasses or contact lenses are not covered. The program’s focus is on medical conditions, not on general vision correction. Therefore, individuals with Original Medicare are responsible for the full cost of these routine services.
The purchase of eyeglasses, contact lenses, and associated fitting services are not covered by Original Medicare. An exception exists for corrective lenses following cataract surgery, where Part B covers one pair of standard glasses or contact lenses. Beyond this specific medical necessity, the costs for vision correction are out-of-pocket expenses.
If an eye exam is conducted to diagnose or monitor a medical eye condition, such as those discussed previously, it falls under Medicare’s coverage. However, if the primary purpose is simply to update a prescription or check general eye health without a specific medical diagnosis, it is considered routine and not covered.
Supplemental Vision Coverage Options
Individuals seeking coverage for routine vision services not included in Original Medicare have several options. Medicare Advantage Plans (Part C) are offered by private companies approved by Medicare and must provide at least the same coverage as Original Medicare. Many Medicare Advantage plans offer additional benefits, often including routine vision, dental, and hearing services. These plans may cover routine eye exams and provide an allowance for eyewear, though specific coverage and costs vary by plan.
Another option is to purchase a standalone vision insurance plan from a private insurer. These policies are separate from Medicare and are designed specifically to cover routine eye care. They offer benefits for routine eye exams, discounts on eyeglasses and contact lenses, and sometimes coverage for lens enhancements. Such plans can be a viable choice for individuals who wish to maintain Original Medicare but also desire coverage for routine vision needs.
Some individuals may also have access to vision benefits through employer-sponsored retiree health plans. These plans can provide comprehensive coverage that supplements Medicare, often including vision care. Community resources might offer low-cost or free vision care for eligible individuals. These alternative coverage avenues help bridge the gap for vision services not covered by Original Medicare.