Does Medicare Pay for Vision? Here’s What’s Covered

Medicare is a federal health insurance program for individuals aged 65 or older, some younger people with disabilities, and those with End-Stage Renal Disease. It helps cover various healthcare costs. Understanding what Medicare covers, particularly for vision services, can be complex, as coverage depends on the type of service and the specific Medicare plan an individual has.

Routine Vision Care and Original Medicare

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), does not cover routine eye care. This includes regular eye exams for corrective lenses, or the costs of eyeglasses and contact lenses. These services are considered routine and fall outside the scope of Original Medicare’s benefits.

Even a simple vision test included in a “Welcome to Medicare” preventive visit, covered by Part B, is an exception. However, it does not extend to ongoing routine eye care for corrective lenses. If an individual needs an annual eye exam for a new eyeglass prescription, Original Medicare requires them to pay the full cost out-of-pocket.

Medically Necessary Eye Care Under Original Medicare

While routine vision care is not covered, Original Medicare Part B provides coverage for medically necessary eye care. This includes diagnosing and treating diseases or conditions that affect the eyes, such as glaucoma, cataracts, age-related macular degeneration (AMD), and diabetic retinopathy.

Part B covers annual glaucoma tests for those at high risk, including individuals with diabetes, a family history of glaucoma, or those of African American or Hispanic descent over certain ages. Annual eye exams for people with diabetes to check for diabetic retinopathy are also covered. Diagnostic tests and treatments for AMD, including certain injections, fall under Part B.

For surgical procedures, Medicare Part B covers medically necessary cataract surgery, including lens removal and intraocular lens (IOL) implantation. After cataract surgery, Part B may also cover one pair of corrective eyeglasses with standard frames or one set of contact lenses.

If inpatient hospitalization is required for eye surgery, Medicare Part A covers the hospital stay. For outpatient procedures, Part B covers 80% of the Medicare-approved amount after the Part B deductible is met, with the individual responsible for the remaining 20% coinsurance.

Medicare Advantage Plans and Vision Benefits

Medicare Advantage (MA) plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans provide all the benefits of Original Medicare (Part A and Part B). Many Medicare Advantage plans also offer additional benefits that Original Medicare does not cover, including routine vision care.

These added vision benefits include annual eye exams and allowances for eyeglasses or contact lenses. The specific scope of vision coverage, such as copayments, allowances for eyewear, and network restrictions, varies significantly by plan and geographic location. Beneficiaries should review plan details to understand the routine vision benefits provided, as some plans may offer discounts on services rather than full coverage.

Other Ways to Cover Vision Costs

For individuals with Original Medicare who desire routine vision coverage, or for costs not covered by any Medicare plan, several other options exist. Stand-alone vision insurance plans are available from private companies, offering coverage for routine eye exams and eyewear. These plans can be purchased to supplement Original Medicare benefits.

Other options include:
Discount vision programs or cards, which provide reduced prices on eye exams, eyeglasses, and contact lenses without requiring an insurance policy.
Vision benefits through employer or union retiree health plans.
State or local programs that offer assistance for low-income individuals.
Paying for vision services directly out-of-pocket, as some providers may offer discounts for cash payments.