Does Medicare Pay for Eye Exams After Cataract Surgery?

Cataract surgery is a common procedure that helps improve vision clouded by cataracts. After undergoing such a procedure, a frequent question arises regarding whether Medicare will cover the follow-up eye care and future vision needs. Understanding Medicare’s specific provisions for eye exams after cataract surgery can help beneficiaries navigate their healthcare expenses.

Medicare Part B Coverage for Post-Cataract Eye Exams

Medicare Part B covers eye exams that are medically necessary, including those directly related to cataract surgery. This coverage extends to pre-surgery evaluations and post-operative care. The services included are generally part of a “global surgical package” that bundles the surgeon’s services before, during, and after the procedure. Major surgeries, such as cataract removal, often have a 90-day global period where follow-up visits related to recovery are included in the initial payment to the surgeon. Medically necessary care also includes addressing any complications that may arise after surgery, even if they require additional office visits or diagnostic tests. Medicare Part B covers 80% of the Medicare-approved amount for these services once the annual Part B deductible has been met. For 2025, the Part B deductible is $257, and after meeting this, beneficiaries are responsible for a 20% coinsurance for most covered services. Additionally, Medicare Part B may cover the cost of one pair of corrective eyeglasses or contact lenses after cataract surgery with an intraocular lens implant.

Original Medicare Coverage for Routine Eye Exams

Original Medicare does not cover routine eye exams. These routine exams are typically those conducted for general vision check-ups, or for prescribing eyeglasses or contact lenses. This means that if an eye exam is solely for the purpose of updating a glasses prescription or for a standard vision test, Original Medicare will not provide coverage. Beneficiaries would be responsible for 100% of the cost for such routine services. However, there are specific situations where Original Medicare Part B will cover eye exams if they are medically necessary to diagnose or treat certain eye conditions. For example, Part B covers annual glaucoma tests for individuals at high risk, which includes those with diabetes, a family history of glaucoma, or certain ethnic backgrounds. It also covers annual exams for diabetic retinopathy if you have diabetes, and certain tests and treatments for age-related macular degeneration. These covered exams are distinct from routine vision screenings and address specific medical concerns rather than general vision correction.

Medicare Advantage Plans and Additional Eye Care

While Original Medicare limits routine vision care, Medicare Advantage Plans (Part C) offer broader coverage. These plans are provided by private insurance companies approved by Medicare and must cover everything Original Medicare covers. Many Medicare Advantage plans include additional benefits that Original Medicare does not, such as routine eye exams, eyeglasses, and contact lenses. Vision benefits, including the frequency of covered exams or allowances for eyewear, vary significantly from one Medicare Advantage plan to another. Some plans may offer a yearly routine eye exam and an allowance for frames and lenses, or even cover certain contact lenses. Beneficiaries should review a plan’s Summary of Benefits or contact the plan provider directly to understand the exact scope of vision coverage, including any limitations or out-of-pocket costs, especially if routine eye care and eyewear are a priority, as a Medicare Advantage plan might offer a more comprehensive solution.