What Type of Vision Coverage Is Covered by Medicare?
Navigate Medicare's vision coverage, from medical eye care to options for routine exams and glasses.
Medicare provides health coverage for millions of individuals, primarily those aged 65 or older, and certain younger people with disabilities. Navigating Medicare can be complex, and a common question concerns vision care. Understanding Medicare’s approach to vision services helps beneficiaries manage their eye health. This involves distinguishing routine vision care from medically necessary services.
Original Medicare Vision Coverage
Original Medicare (Part A and Part B) covers vision services only when medically necessary. Part A’s vision coverage is limited to emergency situations or inpatient hospital stays where vision care is integral to treating a broader medical condition or injury. For instance, if an eye injury necessitates inpatient hospital admission, Part A might cover associated eye care.
Part B extends coverage to specific eye conditions and diseases. For individuals at high risk for glaucoma, Part B covers an annual screening. This includes those with diabetes, a family history of glaucoma, African Americans aged 50 and older, and Hispanic Americans aged 65 and older.
Cataract surgery is also covered when medically necessary, including removal of the cataract and implantation of a standard intraocular lens. This coverage extends to pre-surgery exams and post-surgery care for up to 90 days. However, non-standard lenses or elective refractive surgery are not covered.
For individuals with diabetes, Part B covers an annual eye exam for diabetic retinopathy, a condition that can cause vision loss. This annual exam helps detect signs of damage to the blood vessels in the retina, which is important for early intervention. Additionally, Part B covers the diagnosis and treatment of other medical eye conditions and injuries, such as age-related macular degeneration. This includes physician services, diagnostic tests, and treatments. For services covered under Part B, beneficiaries are responsible for the Part B deductible, which is $257 in 2025, and a 20% coinsurance of the Medicare-approved amount after the deductible is met.
Vision Services Not Covered by Original Medicare
Original Medicare (Part A and Part B) does not cover routine eye care. Standard eye exams, performed to check vision and update prescriptions for eyeglasses or contact lenses, are not covered. Beneficiaries bear the full cost of these routine examinations.
Original Medicare does not cover the cost of eyeglasses or contact lenses. There is a limited exception: Part B will help cover one pair of standard eyeglasses with standard frames or one set of contact lenses after cataract surgery with an intraocular lens. However, any upgrades to frames or lenses beyond the standard offering would be an out-of-pocket expense. Elective procedures, such as LASIK surgery, which reshapes the cornea to correct vision, are not covered because they are not medically necessary.
Medicare Advantage and Other Vision Coverage Options
Individuals seeking coverage for vision services not included in Original Medicare have several options. Medicare Advantage Plans, also known as Part C, are offered by private companies and often bundle additional benefits beyond what Original Medicare covers. These plans include routine vision care, such as annual eye exams, and may provide allowances for eyeglasses or contact lenses. Specific vision benefits and costs vary significantly by plan and geographic area.
For those who prefer to remain with Original Medicare (Parts A and B) but desire routine vision coverage, stand-alone vision insurance plans are available for purchase. These separate policies are designed to cover services like annual eye exams, provide allowances for frames and lenses, and offer discounts on vision-related products. Such plans offer a way to supplement Original Medicare for routine vision needs. Many private insurers offer combined vision and dental packages that can complement Original Medicare.
Medigap, or Medicare Supplement Insurance, helps cover out-of-pocket costs associated with Original Medicare but does not add new benefits like routine vision care. Medigap plans focus on reducing deductibles, coinsurance, and copayments for services covered by Original Medicare. Beneficiaries can explore available plans through the Medicare Plan Finder or by contacting private insurance providers to find options for their vision care needs.