Does Medicare Pay for Vision Exams? What Is Covered

Medicare serves as a federal health insurance program designed to provide coverage for individuals aged 65 or older, some younger people with disabilities, and people with End-Stage Renal Disease. Many beneficiaries often inquire about the extent of vision care coverage under this program. This article aims to clarify how Medicare addresses vision services, detailing what is covered and under what circumstances.

Original Medicare Vision Coverage Explained

Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover routine eye care. Similarly, the cost of eyeglasses or contact lenses for general vision correction is usually not covered by Original Medicare.

This exclusion stems from the program’s focus on medically necessary services for illness or injury, rather than routine or elective vision correction. An exception exists for corrective lenses following cataract surgery, which Part B may cover.

Vision Services Covered Under Original Medicare

While routine vision care is generally not covered, Original Medicare does provide coverage for certain vision-related services deemed medically necessary for diagnosing or treating specific conditions. Medicare Part B will cover diagnostic tests and treatment for eye diseases and conditions.

For individuals with diabetes, Medicare Part B covers an annual eye exam to check for diabetic retinopathy, a condition that can lead to vision loss. Additionally, annual glaucoma tests are covered for those considered at high risk. High-risk factors include having diabetes, a family history of glaucoma, being African American and aged 50 or older, or being Hispanic and aged 65 or older.

Cataract surgery is covered under Medicare Part B. This includes the removal of the cataract and the insertion of an intraocular lens. Pre-operative and post-operative care related to the surgery are also covered services. Following cataract surgery with an intraocular lens implant, Medicare Part B may cover one pair of standard eyeglasses with standard frames or one set of contact lenses from a Medicare-enrolled supplier. Medicare also covers diagnostic tests and treatment for age-related macular degeneration (AMD), which may include eye injections.

Medicare Advantage Plans and Vision Coverage

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. Unlike Original Medicare, many Medicare Advantage plans provide additional benefits that can include routine vision exams, as well as allowances for eyeglasses or contact lenses.

Specific benefits, provider networks, and out-of-pocket costs vary by plan and geographic area. Individuals must be enrolled in Original Medicare (Parts A and B) to be eligible for a Medicare Advantage plan. It is advisable to review the specific details of any Medicare Advantage plan to understand its vision benefits.

Accessing Covered Vision Services

To access vision services covered by Original Medicare, confirm that the eye care professional accepts Medicare assignment. Accepting assignment means the provider agrees to accept the Medicare-approved amount as full payment for covered services. For those with Medicare Advantage plans, use providers within the plan’s network to ensure coverage and manage costs effectively.

For services covered under Original Medicare Part B, beneficiaries are typically responsible for the Part B deductible, which is $257 in 2025, and then a 20% coinsurance of the Medicare-approved amount. If a covered service is performed in a hospital outpatient setting, an additional copayment may apply. Providers typically bill Medicare directly for covered services. When a service is not covered by Medicare, the individual will be responsible for the full cost, and providers should inform the patient of this before rendering care.