Does Medicare Pay for Eye Exams and Glasses?
Understand Medicare's complex eye care coverage for exams and glasses, including differences between Original Medicare and Advantage plans.
Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, offers coverage for medical services. Understanding Medicare’s approach to eye care can be complex, as coverage depends on the type of exam and the specific Medicare plan. This overview clarifies the provisions and exceptions concerning eye exams and vision correction under Medicare.
Original Medicare’s Approach to Eye Care
Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), does not cover routine eye exams. These exams are for prescribing eyeglasses or contact lenses to correct vision. Individuals are responsible for 100% of the cost for such routine services.
Medicare Part B does cover a simple vision test during the one-time “Welcome to Medicare” preventive visit. This visit is offered within the first year of enrolling in Part B. This is a basic screening, not a comprehensive eye exam for vision correction. Original Medicare focuses on medically necessary services.
Specific Eye Conditions and Medical Coverage
Original Medicare Part B covers eye care when it is medically necessary due to specific diseases or injuries. This includes diagnostic tests and treatments for several common eye conditions. For instance, Medicare Part B covers an annual eye exam for individuals with diabetes to screen for diabetic retinopathy, a condition where high blood sugar damages the retina’s blood vessels. This exam aids in early detection and management.
Glaucoma screenings are also covered annually for those considered at high risk, such as individuals with diabetes, a family history of glaucoma, or certain ethnic backgrounds like African Americans aged 50 and older or Hispanic individuals aged 65 and over. After meeting the annual Part B deductible ($257 in 2025), individuals pay 20% of the Medicare-approved amount for these medically necessary services. Medicare Part B also covers diagnostic tests and treatments for age-related macular degeneration (AMD), including eye injections to slow vision loss.
Medicare Advantage Plans and Vision Benefits
Medicare Advantage Plans, also known as Part C, are offered by private insurance companies approved by Medicare and provide a broader range of benefits than Original Medicare. These plans are required to cover at least the same services as Original Medicare Parts A and B, and they include additional benefits. Many Medicare Advantage plans offer coverage for routine eye exams, eyeglasses, and contact lenses.
The specific vision benefits, including limitations, provider networks, and cost-sharing requirements, vary among different Medicare Advantage plans. For example, some plans may offer a yearly routine eye exam at no cost and an allowance for eyewear. Individuals should review the details of their specific plan to understand the extent of vision coverage provided.
Coverage for Eyeglasses and Contact Lenses
Original Medicare does not cover eyeglasses or contact lenses for routine vision correction. An exception relates to cataract surgery. Medicare Part B covers the cost of one pair of eyeglasses or one set of contact lenses after cataract surgery that includes an intraocular lens implant.
This coverage applies to standard frames and lenses, and individuals may incur additional costs if they choose upgraded frames or specialty lenses. The corrective lenses must be obtained from a supplier enrolled in Medicare.