Does Original Medicare Cover Vision Care?

Medicare is a federal health insurance program for individuals aged 65 or older, younger people with certain disabilities, and those with End-Stage Renal Disease. Understanding the extent of vision care coverage is important for managing healthcare expenses.

Routine Vision Coverage Under Original Medicare

Original Medicare, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover routine eye care services. This includes regular eye exams to check vision and update prescriptions for eyeglasses or contact lenses. Consequently, the costs associated with purchasing eyeglasses or contact lenses are also not covered.

These types of services are considered “routine” or “elective” vision care, rather than medically necessary treatments for specific conditions.

Medically Necessary Eye Care Covered by Original Medicare

While routine vision care is largely excluded, Original Medicare Part B covers eye care services deemed medically necessary. This includes the diagnosis and treatment of specific eye diseases and conditions that affect vision, such as glaucoma, cataracts, and diabetic retinopathy.

For individuals at high risk for glaucoma, such as those with diabetes or a family history of the condition, Medicare Part B covers an annual glaucoma screening. Eye exams for individuals with diabetes to check for diabetic retinopathy are covered once a year. Diagnostic tests and treatments for age-related macular degeneration also fall under medically necessary coverage.

Cataract surgery, a common procedure to remove a cloudy lens, is covered by Medicare Part B when medically necessary. Following cataract surgery, Medicare Part B also covers one pair of standard prescription eyeglasses or a set of contact lenses. Beneficiaries typically pay 20% of the Medicare-approved amount for these services after meeting the Part B deductible.

Options for Comprehensive Vision Coverage

For those seeking more comprehensive vision benefits, several avenues exist. Medicare Advantage plans, also known as Medicare Part C, are offered by private companies approved by Medicare and often include additional benefits. Many of these plans bundle vision coverage, providing benefits for routine eye exams, eyeglasses, and contact lenses. The specific coverage and costs can vary significantly between different Medicare Advantage plans, so it is important to review plan details.

Another option is to purchase a stand-alone vision insurance policy from a private insurer. These plans are designed specifically to cover routine eye care services, including annual eye exams and allowances for eyewear, that Original Medicare does not. Companies like VSP and Humana offer individual vision plans, which can provide savings on exams, frames, and lenses.

Some individuals might have access to vision benefits through other sources, such as employer or union retiree benefits. For those with limited income, Medicaid programs may offer some vision coverage, though the extent of these benefits varies significantly by state.