Does Medicare Part A and B Cover Vision?
Understand what vision services Medicare Part A and B cover and what they don't. Learn about medically necessary eye care vs. routine exams.
Original Medicare, a federal health insurance program, consists of Part A and Part B. Part A primarily covers hospital insurance, while Part B covers medical insurance, including doctor visits and outpatient care. While these components provide extensive health coverage, Original Medicare generally does not cover routine vision care services. However, it does provide coverage for eye care that is considered medically necessary to diagnose or treat specific eye diseases and conditions.
Medicare Part A Vision Coverage
Medicare Part A, hospital insurance, offers limited vision coverage, primarily focusing on inpatient services. This includes care for eye conditions or injuries that necessitate a hospital stay. For instance, severe eye trauma or medically necessary eye surgery requiring a hospital stay falls under Part A. Coverage also extends to emergency eye care received within a hospital.
Part A covers the hospital stay and associated services, not routine eye exams or corrective lenses. If a prosthetic eye requires surgical implantation in an inpatient facility, Part A may cover the hospital costs.
Medicare Part B Vision Coverage
Medicare Part B, medical insurance, is the primary component of Original Medicare covering medically necessary eye care. This includes diagnostic tests and treatment for various eye diseases and conditions. For example, Part B covers annual glaucoma screenings for individuals considered at high risk, such as those with diabetes, a family history of glaucoma, or African Americans aged 50 and older, or Hispanic individuals aged 65 and over. It also covers treatments for glaucoma, including medicated eye drops and surgical procedures.
Cataract surgery, including the implantation of an intraocular lens, is covered by Medicare Part B. Following cataract surgery, Part B also covers one pair of corrective eyeglasses with standard frames or one set of contact lenses. For individuals diagnosed with diabetes, Part B covers one eye exam per year to check for diabetic retinopathy, a condition that can lead to vision loss.
Part B also covers diagnostic tests and treatment for age-related macular degeneration (AMD), including eye injections and laser treatments. If a prosthetic eye is medically necessary, Part B covers the device and related services, including polishing and resurfacing of the eye twice a year. Beneficiaries typically pay 20% of the Medicare-approved amount for these services after meeting the Part B deductible, which is $257 in 2025.
Vision Services Not Covered by Original Medicare
Original Medicare (Part A and Part B) generally does not cover routine vision services. This includes routine eye exams (eye refractions) performed to determine a prescription for corrective lenses. The cost of eyeglasses, contact lenses, and their fitting fees are not covered, with the exception of one pair of corrective lenses after cataract surgery.
Elective refractive eye surgeries, such as LASIK, are not covered by Original Medicare as they are considered elective procedures, not medically necessary treatments. These procedures aim to improve vision that can otherwise be corrected with glasses or contact lenses. Services deemed cosmetic or not medically essential, even if vision-related, fall outside Original Medicare’s coverage.
Options for Additional Vision Coverage
Several options exist for beneficiaries seeking more comprehensive coverage. Medicare Advantage Plans (Part C) are offered by private insurance companies approved by Medicare. These plans are required to cover everything Original Medicare covers, and most include additional benefits such as routine vision care, including eye exams, eyeglasses, and contact lenses. The specific vision benefits and out-of-pocket costs can vary significantly between different Medicare Advantage plans.
Another option is purchasing a standalone vision insurance plan. These plans can provide coverage for routine eye exams and eyewear.
For individuals who qualify based on income and other criteria, Medicaid may offer vision benefits, which often include routine eye exams and eyeglasses, though coverage for adults can vary by state. Veterans may also be eligible for vision care benefits through the Department of Veterans Affairs (VA) healthcare system, which can include routine eye exams and, in some cases, eyeglasses, especially if related to a service-connected condition.