Does Medicare Part A and B Cover Vision Care?
Navigate Medicare vision coverage. Learn what Part A & B cover for medical eye care, what's not included, and how to get routine vision benefits.
Original Medicare (Parts A and B) covers various healthcare services but generally excludes routine vision care like standard eye exams, eyeglasses, or contact lenses. It does, however, cover medically necessary eye care for treating diseases, injuries, or specific medical conditions affecting the eyes. This distinction between routine and medically necessary care is central to understanding Medicare’s vision benefits.
Medicare Part A and Part B Vision Coverage
Medicare Part A, hospital insurance, covers inpatient care for eye conditions or injuries. This includes hospital stays for eye surgery or medical emergencies impacting the eyes. For instance, if an eye infection requires hospitalization, Part A helps cover the inpatient stay and associated care.
Medicare Part B, medical insurance, covers a broader range of medically necessary outpatient eye care. This includes diagnostic tests and treatment for eye diseases like glaucoma, cataracts, age-related macular degeneration (AMD), and diabetic retinopathy. Part B covers annual glaucoma screenings for high-risk individuals (e.g., those with diabetes, a family history of glaucoma, certain ethnic backgrounds, or certain ages). It also covers yearly eye exams for individuals with diabetes to screen for diabetic retinopathy.
Cataract surgery, including basic intraocular lenses, is covered by Medicare Part B. After cataract surgery that implants an intraocular lens, Part B covers one pair of standard eyeglasses or contact lenses from a Medicare-enrolled supplier. Part B also covers medically necessary prosthetic eyes. Beneficiaries are responsible for the Part B deductible and a 20% coinsurance of the Medicare-approved amount.
Services Not Covered by Medicare Part A or Part B
Original Medicare does not cover routine vision services aimed at correcting vision or maintaining general eye health. This includes regular eye exams primarily conducted to determine prescriptions for eyeglasses or contact lenses. These routine check-ups are separate from the diagnosis or treatment of specific eye diseases.
The cost of eyeglasses (frames and lenses) and contact lenses is generally not covered, except for one pair after qualifying cataract surgery. Elective surgical procedures like LASIK, performed to correct refractive errors (e.g., nearsightedness, farsightedness, astigmatism), are also not covered. These procedures are considered elective because vision correction can typically be achieved with non-surgical alternatives.
Alternative Vision Coverage Options
Medicare Advantage Plans (Medicare Part C) are offered by private insurance companies and often include benefits beyond Original Medicare, such as routine vision care. These plans frequently cover routine eye exams, offer allowances for eyeglasses and contact lenses, and may provide discounts for refractive surgeries like LASIK. Enrolling in a Medicare Advantage Plan means you receive your Medicare Part A and Part B benefits through the private plan, which often operates with its own provider network and specific cost-sharing rules like copayments and deductibles.
Another option is a stand-alone vision insurance plan, a separate policy designed to cover routine eye care. These plans typically involve a monthly premium and may have deductibles, copayments, or annual allowances for eyewear. Individuals can purchase these plans in addition to Original Medicare. Other resources include discount programs from vision providers or community health clinics offering lower-cost services. When considering alternative vision coverage, review the plan’s specific benefits, provider network, and out-of-pocket costs.