Does Regular Medicare Cover Eye Exams?
Unsure if Medicare covers your eye exams? Learn what Original Medicare, Medicare Advantage, and supplemental plans offer for vision care.
Medicare is a federal health insurance program for individuals aged 65 or older, as well as certain younger people with disabilities. Understanding how this program covers eye exams and related vision services is important for beneficiaries. This article aims to clarify the distinctions in coverage under different Medicare options.
Original Medicare Coverage for Routine Eye Care
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), does not cover routine eye exams. Services solely for checking vision, prescribing eyeglasses, or providing contact lenses are not covered. Beneficiaries pay 100% of the costs for these routine services. A simple vision test may be included in the “Welcome to Medicare” preventive visit, but this is a one-time benefit within the first year of enrolling in Part B and is not comprehensive routine care.
Original Medicare Coverage for Medically Necessary Eye Care
Original Medicare covers medically necessary eye services. This includes diagnosis and treatment of specific eye diseases, conditions, or injuries. Medicare Part B covers diagnostic tests and treatment for conditions like glaucoma, cataracts, and age-related macular degeneration. Coverage applies even if test results are negative, provided there is a medical reason for the examination.
Specific screenings are covered for high-risk individuals. Part B covers an annual eye exam for diabetic retinopathy if you have diabetes. An annual glaucoma test is covered for high-risk individuals, including those with diabetes, a family history of glaucoma, or certain racial backgrounds.
For covered services under Part B, beneficiaries pay 20% of the Medicare-approved amount after meeting the annual Part B deductible. Cataract surgery, including lens implantation, is also covered by Part B. Following cataract surgery, Part B also covers one pair of eyeglasses with standard frames or one set of contact lenses.
Medicare Advantage Plans and Vision Coverage
Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits. These plans are provided by private companies approved by Medicare and must cover all services included in Original Medicare Parts A and B. Many Medicare Advantage plans also include additional benefits not covered by Original Medicare, such as routine vision care.
These plans often cover routine eye exams and may include allowances for eyeglasses or contact lenses. Specific vision benefits, including coverage limits, networks, copayments, and deductibles, vary significantly between plans. Individuals should review each plan’s details to understand its specific vision offerings.
Supplemental Vision Coverage
Individuals seeking vision coverage beyond Original Medicare, and not choosing a Medicare Advantage plan, can purchase standalone vision insurance policies. These plans are offered by private companies and are separate from health insurance. Standalone vision insurance covers routine eye exams, eyeglasses, and contact lenses.
These policies involve monthly or annual premiums. They feature copayments for services, such as a fixed amount for an eye exam or a portion of the cost for eyewear, and may include an allowance for frames or contact lenses. Many plans operate within a network of providers, offering lower out-of-pocket costs when choosing an in-network eye doctor.