How Often Does Medicare Cover Eye Exams?

Medicare’s approach to eye care coverage can appear complex, varying significantly based on the type of service and the specific Medicare plan a beneficiary holds. Understanding what is covered and how frequently is essential for managing eye health and associated costs. This article clarifies the details of Medicare eye care benefits, from routine check-ups to medically necessary treatments.

Original Medicare Coverage for Eye Care

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), does not cover routine eye exams for prescribing eyeglasses or contact lenses. Routine vision services, such as simple eye refractions, are considered outside the scope of medically necessary care covered by Part B. However, a basic vision test might be included during a beneficiary’s “Welcome to Medicare” preventive visit, which occurs once within the first year of enrolling in Part B.

Original Medicare Part B covers specific eye care services when medically necessary for diagnosis or treatment. For individuals at high risk for glaucoma, Medicare Part B covers an annual glaucoma screening. High-risk factors include:
Having diabetes
A family history of glaucoma
Being African American and age 50 or older
Being Hispanic and age 65 or older

For those diagnosed with diabetes, Medicare Part B covers an annual eye exam to check for diabetic retinopathy, a condition that can damage blood vessels in the eye. Medicare Part B also covers diagnostic tests and treatment for age-related macular degeneration (AMD), a progressive condition that can lead to central vision loss. Covered treatments for AMD may include eye injections and photodynamic therapy.

Cataract surgery is covered by Medicare Part B. This coverage includes exams leading up to and following the surgery, as well as the procedure itself, which often involves implanting an intraocular lens. Following cataract surgery that implants an intraocular lens, Medicare Part B helps cover the cost of one pair of eyeglasses with standard frames or one set of contact lenses. Medicare Part B also covers the diagnosis and treatment of other medically necessary eye diseases or injuries.

Medicare Advantage Plan Eye Benefits

Medicare Advantage Plans, also known as Part C, are offered by private insurance companies approved by Medicare. These plans are an alternative way to receive Medicare benefits and are required to cover all services Original Medicare (Parts A and B) covers, with the exception of hospice care. Many Medicare Advantage plans provide additional benefits that Original Medicare does not, frequently including coverage for routine eye exams.

These supplemental benefits often extend to covering eyeglasses and contact lenses, which are not covered by Original Medicare. The specific scope of vision coverage, such as the frequency of routine exams or the allowance for eyewear, varies significantly by plan and location. Beneficiaries considering a Medicare Advantage plan for routine eye care should carefully review the plan’s details. Some plans may require the use of in-network providers for these added benefits, which can influence out-of-pocket costs.

Out-of-Pocket Costs for Eye Care

Even when Medicare covers eye care services, beneficiaries are responsible for out-of-pocket costs. For services covered by Original Medicare Part B, an annual deductible applies before Medicare pays its share. In 2025, the Part B deductible is $257. After this deductible is met, beneficiaries pay a coinsurance of 20% of the Medicare-approved amount for most covered medically necessary eye services. If services are received in a hospital outpatient setting, additional copayments may apply.

For Medicare Advantage plans, out-of-pocket costs can vary widely depending on the specific plan’s structure. These plans may have their own deductibles, copayments, or coinsurance amounts for both medically necessary and routine eye care. It is important to review the plan’s Summary of Benefits to understand the cost-sharing requirements. Services not covered by Medicare or those exceeding a plan’s benefit limits will be 100% out-of-pocket for the beneficiary, unless other insurance or programs apply.

Medicare Supplement Insurance, also known as Medigap plans, can help cover some out-of-pocket costs associated with Original Medicare, such as deductibles, coinsurance, and copayments. While Medigap plans assist with costs for services covered by Original Medicare, they do not provide additional coverage for routine vision care like eye exams or eyeglasses. If a medically necessary eye condition is covered by Original Medicare, a Medigap plan can help reduce the beneficiary’s share of the cost.

Finding Covered Eye Care Services

Locating eye care providers who accept Medicare is a practical step for beneficiaries seeking covered services. The official Medicare.gov website provides a “Care Compare” tool, allowing individuals to search for ophthalmologists and optometrists enrolled in Medicare within a specific geographic area.

When scheduling an appointment, confirm directly with the provider’s office that they accept Medicare and verify coverage for the specific eye service needed. This helps ensure the service will be covered and clarifies potential out-of-pocket expenses. For those enrolled in a Medicare Advantage plan, consult the plan’s provider directory or contact the plan directly to find in-network eye care professionals for both medically necessary and routine vision benefits.