Does Medicare Pay for Eye Exams and Eyeglasses?
Understand how Medicare covers eye exams and eyeglasses. Explore your options for vision care, from routine to medical needs.
Medicare, a federal health insurance program, plays a significant role in helping older adults and certain younger people with disabilities manage their healthcare expenses. Maintaining eye health is important with age, as regular eye exams can help detect potential issues early. Understanding how Medicare addresses vision care is important for beneficiaries navigating their healthcare options.
Original Medicare Eye Coverage
Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover routine eye exams, eyeglasses, or contact lenses. Coverage is primarily limited to medically necessary services and treatments for specific eye diseases or injuries. For example, Medicare Part B helps cover a yearly eye exam for diabetic retinopathy if you have diabetes. Part B also covers glaucoma tests once every 12 months for individuals at high risk, such as those with diabetes, a family history of glaucoma, or certain ethnic backgrounds at specific ages. Tests and treatments for age-related macular degeneration are also covered under Part B.
Original Medicare also covers medically necessary cataract surgery. This includes coverage for one set of corrective lenses after an intraocular lens implant. For most covered services, beneficiaries are responsible for 20% of the Medicare-approved amount after meeting the Part B deductible.
Medicare Advantage Plans and Eye Care
Medicare Advantage Plans (Part C) are private insurance plans approved by Medicare that offer an alternative way to receive Medicare benefits. While required to cover everything Original Medicare does, many also offer additional benefits like routine vision care. These plans often include coverage for routine eye exams and may provide allowances for eyeglasses or contact lenses. Specific vision benefits, including exam frequency and eyewear allowances, vary significantly from one Medicare Advantage plan to another. Beneficiaries should review the plan’s Summary of Benefits to understand coverage details and associated out-of-pocket costs.
Supplemental and Standalone Vision Coverage
Beyond Original Medicare and Medicare Advantage, individuals have other options for vision care. Medigap, or Medicare Supplement Insurance plans, do not provide coverage for routine vision care. These plans are designed to help cover some of the out-of-pocket costs associated with services that Original Medicare covers.
For those seeking coverage for routine eye exams, eyeglasses, or contact lenses, standalone vision insurance plans are available. These separate policies are an option for individuals with Original Medicare who desire routine vision benefits, or for those with a Medicare Advantage plan whose vision coverage is insufficient. Standalone plans cover annual eye exams and provide allowances or discounts for frames and lenses. Monthly premiums for these plans can vary, with some starting from approximately $10 to $30 per month.