Does Medicare Cover Yearly Eye Exams?

Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. Medicare’s coverage for eye care can seem complex, as support depends on the specific type of service received. Understanding these distinctions helps clarify what eye care expenses may be covered.

Routine Eye Exams

Original Medicare generally does not cover routine eye exams. These examinations are performed to check overall vision, update prescriptions for corrective lenses, or screen for potential eye conditions without specific medical symptoms or diagnosed issues.

Medically Necessary Eye Care

While routine vision services generally lack coverage, Medicare offers support for eye care deemed medically necessary. This includes examinations and treatments for specific eye diseases and conditions requiring medical intervention. Coverage applies when a diagnosed medical condition affects the eyes, rather than just a need for vision correction or a general check-up.

For instance, Original Medicare Part B covers diagnostic tests and treatments for conditions such as glaucoma, cataracts, diabetic retinopathy, and age-related macular degeneration. If you have symptoms or a diagnosed condition, Medicare Part B helps cover costs of exams, tests, and treatments for that medical issue. This includes procedures like cataract surgery, which is a common example of a medically necessary service.

Part B also covers certain diagnostic tests for specific eye problems, such as glaucoma screenings if you are at high risk, or retinal exams for individuals with diabetes. Following a covered surgical procedure, such as cataract removal, Medicare Part B will also cover necessary follow-up care. The intent is to cover services addressing a medical problem, not just improving vision.

Eyeglasses and Contact Lenses

Original Medicare typically does not cover eyeglasses or contact lenses for routine vision correction. The program’s focus remains on medically necessary services rather than general vision enhancement. Most people needing new glasses for everyday use will find these costs are not covered under their Original Medicare benefits.

There is one specific exception to this general rule regarding corrective eyewear. Original Medicare Part B will cover one pair of eyeglasses or contact lenses following cataract surgery that involves the implantation of an intraocular lens. This coverage is directly tied to the surgical procedure, recognizing the need for post-operative vision correction. Beyond this specific scenario, coverage for glasses or contacts is not provided.

Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, are offered by private companies approved by Medicare. These plans must cover all Original Medicare benefits, and often provide additional benefits Original Medicare does not. Many Medicare Advantage plans include coverage for routine eye exams, eyeglasses, and/or contact lenses.

The specific vision benefits offered by a Medicare Advantage plan can vary significantly from one plan to another. Some plans might cover a yearly routine eye exam and provide an allowance for frames or lenses, while others may have different structures. Individuals interested in obtaining routine vision benefits through Medicare should carefully review the details of various Medicare Advantage plans available in their area.