Does Original Medicare Cover Eye Exams?

Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), is the federal government’s primary health insurance program for individuals typically aged 65 or older, as well as some younger people with disabilities. Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Part B helps cover outpatient medical services, including doctor visits, preventive services, and durable medical equipment.

Routine Eye Exams

Original Medicare (Parts A and B) generally does not cover routine eye exams. These examinations, often called “eye refractions,” are performed to check vision for eyeglasses or contact lenses. Individuals typically pay 100% of the cost for these assessments.

A simple vision test is included in the “Welcome to Medicare” preventive visit, which is covered by Medicare Part B. This initial visit is offered once within the first year of enrolling in Part B. This is distinct from a comprehensive routine eye exam for general vision correction or overall eye health check-ups.

Eye Conditions and Diseases

Original Medicare covers eye care services when medically necessary to diagnose or treat specific eye conditions and diseases. These services fall under Medicare Part B. This includes various tests and treatments for chronic eye problems that could lead to vision loss.

For individuals with diabetes, Medicare Part B covers one eye exam for diabetic retinopathy each year. This annual exam checks the back of the eyes for signs of damage from diabetes and must be performed by an eye doctor legally allowed to conduct the test in the state. Early detection through such screenings can help prevent or delay vision loss in a significant percentage of people with diabetes.

Glaucoma screenings are also covered by Medicare Part B once every 12 months for individuals considered at high risk. High-risk factors include having diabetes, a family history of glaucoma, or being African American and age 50 or older, or Hispanic American and age 65 or older. These screenings are important because glaucoma symptoms often progress slowly without noticeable signs until the disease is advanced.

Cataract surgery and related care are covered under Medicare Part B when medically necessary. This includes pre-operative exams, the surgical removal of the cataract, and the implantation of a basic intraocular lens. Medicare generally covers 80% of the Medicare-approved amount for these services after the Part B deductible is met. Medicare Part B also covers diagnostic tests and treatments for age-related macular degeneration (AMD).

Eyeglasses and Contact Lenses

Original Medicare generally does not cover the cost of eyeglasses or contact lenses for routine vision correction. For most corrective eyewear needs, individuals are responsible for 100% of the costs.

There is an exception where Medicare Part B provides coverage for corrective lenses: after cataract surgery with an intraocular lens implant. In such cases, Medicare Part B helps cover one pair of eyeglasses with standard frames or one set of contact lenses. After meeting the Part B deductible, individuals typically pay 20% of the Medicare-approved amount for these corrective lenses. Any additional costs for upgraded frames or non-standard lenses are not covered.