Does Medicare Pay for Eye Exams? What’s Covered
Decipher Medicare's eye exam and vision care coverage. Understand what's included, what isn't, and your potential costs.
Medicare is a federal health insurance program that provides coverage for individuals aged 65 or older, as well as some younger people with certain disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). Medicare coverage for eye care differentiates between routine vision services and those considered medically necessary.
Original Medicare and Routine Vision
Original Medicare (Part A and Part B) generally does not cover routine eye exams, eyeglasses, or contact lenses. Beneficiaries typically bear the full cost for services solely intended to check vision or provide corrective lenses.
Original Medicare Part B does cover specific diagnostic screenings for certain eye conditions. For instance, an annual glaucoma test is covered for individuals considered at high risk, including those with diabetes, a family history of glaucoma, African Americans aged 50 or older, or Hispanics aged 65 or older. Part B also helps pay for an annual diabetic eye exam if an individual has diabetes or diabetic retinopathy.
Original Medicare and Medically Necessary Eye Care
Original Medicare Part B provides coverage for eye care services deemed medically necessary to diagnose or treat an eye disease or condition. This includes eye exams for conditions such as glaucoma, cataracts, or diabetic retinopathy.
Cataract surgery is covered by Medicare Part B. This coverage includes the removal of the cataract and the implantation of a basic intraocular lens. Following cataract surgery, Medicare Part B will also help cover the cost of one pair of prescription eyeglasses with standard frames or one set of contact lenses. This post-surgical eyewear coverage is an exception to the general rule of non-coverage for corrective lenses.
Medicare Part B also covers medically necessary artificial eyes when ordered by a doctor or other healthcare provider. This includes the cost of the prosthetic eye itself, along with routine maintenance and repairs. For coverage, the natural eye must have been removed due to a medical condition.
Medicare Advantage Vision Benefits
Medicare Advantage Plans, also known as Part C, are health plan options offered by private companies approved by Medicare. These plans are required to provide all the benefits of Original Medicare (Part A and Part B). A key difference is that Medicare Advantage plans frequently offer additional benefits not covered by Original Medicare.
Many Medicare Advantage plans include coverage for routine eye exams, as well as allowances for eyeglasses and contact lenses. The specific vision benefits, including the frequency of exams and the allowance for eyewear, can vary significantly from one plan to another. Beneficiaries considering a Medicare Advantage plan should carefully review the plan’s specific details to understand the extent of its vision coverage.
Out-of-Pocket Expenses for Eye Care
Even when eye care services are covered by Medicare, beneficiaries are typically responsible for certain out-of-pocket costs. For Original Medicare Part B, the annual deductible must be met before Medicare begins to pay its share. In 2025, the Part B deductible is $257.
After the deductible has been satisfied, Medicare generally pays 80% of the Medicare-approved amount for covered services. The beneficiary is then responsible for the remaining 20% coinsurance. If services are received in a hospital outpatient setting, a copayment may also apply. For any services not covered by Medicare, such as routine eye exams under Original Medicare, the beneficiary is responsible for 100% of the cost.