Does Medicare Part B Cover Eye Exams?

Medicare Part B, the medical insurance component of Original Medicare, covers a range of outpatient health services. Its coverage for eye exams and vision services focuses on medical conditions rather than routine vision correction. Understanding these distinctions helps beneficiaries manage healthcare expenses effectively.

Medicare Part B Eye Exam Coverage

Medicare Part B covers eye exams that are medically necessary to diagnose or treat an eye disease or condition. A medically necessary eye exam is required due to an illness, injury, or to monitor an existing eye condition. For instance, if an individual experiences sudden vision changes, pain, or has a diagnosed medical condition affecting their eyes, the associated eye exam is covered.

Specific Medical Eye Conditions Covered

Medicare Part B covers eye exams and screenings for certain medical conditions. For individuals at high risk of glaucoma, Part B covers an annual glaucoma screening. High-risk factors include diabetes, a family history of glaucoma, being African American and 50 or older, or Hispanic and 65 or older. This screening involves an eye doctor legally allowed to perform glaucoma tests.

Part B also covers a yearly eye exam for people with diabetes to check for diabetic retinopathy, a condition that can damage the eye’s blood vessels and lead to vision loss. This exam aids in early detection and management of diabetes-related eye complications. Additionally, Part B covers exams leading up to and following cataract surgery. This coverage extends to cataract removal and basic intraocular lens implants.

Your Out-of-Pocket Costs

When Medicare Part B covers an eye exam or service, beneficiaries are responsible for out-of-pocket costs. The annual Medicare Part B deductible, which is $257 for 2025, must be met before Medicare pays its share. After this deductible is satisfied, beneficiaries typically pay 20% of the Medicare-approved amount for most covered outpatient services, including medically necessary eye care.

Medicare pays the remaining 80% of the approved amount. Beneficiaries should choose healthcare providers who accept “assignment,” meaning they agree to accept the Medicare-approved amount as full payment. Providers who accept assignment cannot charge beneficiaries more than the Medicare deductible and coinsurance. An additional copayment may apply if a service is performed in a hospital outpatient setting.

Services Not Covered by Part B

Medicare Part B generally does not cover routine eye exams for vision correction, such as those for eyeglasses or contact lenses. These routine vision services are typically considered elective, and beneficiaries are responsible for 100% of their cost.

Part B typically does not cover eyeglasses or contact lenses. However, an exception exists: Part B helps cover one pair of eyeglasses with standard frames or one set of contact lenses after each cataract surgery that implants an intraocular lens. Upgrades to frames beyond standard options result in additional out-of-pocket costs. The supplier providing these corrective lenses must be enrolled in Medicare.