How Much Does Medicare Pay for Eye Exams?

Medicare, a federal health insurance program, helps millions of people manage their healthcare needs. Understanding its coverage for various services, including vision care, can be intricate due to the different components of the program. This article aims to clarify how Medicare addresses eye exams and related vision services, offering insights into what is covered and under what conditions.

Original Medicare Eye Exam Coverage

Original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), generally does not cover routine eye exams. This means eye refractions for vision correction, such as for eyeglasses or contact lenses, are typically not included. A simple vision test may be part of the “Welcome to Medicare” preventive visit, a one-time benefit provided within the first year of enrolling in Part B.

Medicare Part B does cover eye exams considered medically necessary for diagnosing and treating specific eye diseases or conditions. These are treated as medical services rather than routine vision care. For instance, annual eye exams are covered for individuals with diabetes to check for diabetic retinopathy, a condition affecting the blood vessels in the eyes.

Furthermore, Medicare Part B covers yearly glaucoma tests for individuals at high risk, including those with a family history of glaucoma, African Americans aged 50 or older, or Hispanic individuals aged 65 or older. Diagnostic tests and treatments for age-related macular degeneration (AMD) and cataracts are also covered.

Original Medicare Eyewear Coverage

Original Medicare does not cover eyeglasses, contact lenses, or the services required to fit them for routine vision correction.

However, Medicare Part B does cover one pair of eyeglasses with standard frames or one set of contact lenses after cataract surgery with an intraocular lens (IOL) implant. This coverage is for the initial corrective lenses needed following the surgery, not for subsequent or cosmetic upgrades. The eyeglasses or contact lenses must be obtained from a Medicare-enrolled supplier for coverage to apply.

Medicare Advantage Eye Care Coverage

Medicare Advantage Plans, also known as Medicare Part C, are private insurance plans approved by Medicare that offer an alternative way to receive Medicare Part A and Part B benefits. Many of these plans often provide additional benefits not covered by Original Medicare, including vision care.

Many Medicare Advantage plans include coverage for routine eye exams, eyeglasses, and sometimes contact lenses. However, the specific vision services and the extent of coverage can vary significantly from one Medicare Advantage plan to another.

These plans often have their own specific copayments, deductibles, or limitations on vision services, which may differ from Original Medicare’s cost-sharing structure. Individuals should review the plan’s Summary of Benefits or contact the plan provider to understand the coverage details, including any allowances for eyewear or network restrictions.

Your Out-of-Pocket Costs

For eye care services covered by Original Medicare Part B, beneficiaries typically face out-of-pocket costs. After meeting the annual Medicare Part B deductible, which is $257 in 2025, individuals are generally responsible for 20% of the Medicare-approved amount for the service. This 20% share is known as coinsurance and applies to most covered medical services under Part B.

In some situations, a healthcare provider might not accept Medicare assignment, meaning they do not agree to Medicare’s approved amount as full payment. While this is uncommon for most primary care providers, a non-participating provider can balance bill you for up to 15% above Medicare’s approved amount. This additional charge is separate from your deductible and coinsurance.

Medicare Supplement Insurance, also known as Medigap, can help cover some of these out-of-pocket costs that Original Medicare does not. Medigap plans are sold by private companies and can help pay for the Part B deductible and coinsurance for services that Original Medicare covers. However, Medigap plans generally do not cover services that Original Medicare does not cover, such as routine vision care or eyeglasses, unless tied to a specific medical event like cataract surgery.