Does Medicare Cover Eye Exams?

Key Takeaways

• Generally, Original Medicare doesn’t cover routine eye exams for corrective vision. These include exams for eyeglasses or contact lenses. However, Medicare Advantage plans might offer additional coverage that can include limited corrective vision care.

• Medicare Part B does cover medically necessary exams due to a specific eye disease or conditions such as cataract surgery, glaucoma, macular degeneration, or diabetes-related eye problems. They key is medical necessity.

• Medicare Part B will cover exams for diabetic retinopathy and Glaucoma if you are diabetic or your doctor indicates you are at high risk

• Medicare Part B covers cataract surgery and post cataract care, including a pair of glasses.

Does Medicare Cover Vision Care and Annual Eye Exams?

Medicare does not cover routine eye exams for corrective vision.

A simple vision test is included in the “Welcome to Medicare” preventive visit. This is covered by Medicare Part B at 100%. However, it’s offered only once and only within the first year of Part B coverage.

While Medicare may cover some eye exams, Medicare coverage doesn’t include related services such as eyeglasses or contacts, unless they are medically necessary due to a covered eye condition.

Does Medicare Cover Eye Exams for Diabetics?

Yes, Medicare Part B will generally cover eye exams for diabetic retinopathy and Glaucoma.

Medicare will cover eye exams for diabetics once every 12 months or more often if medically necessary. During the annual eye exam, the eye doctor will dilate the pupils and examine the retina and other parts of the eye to look for signs of damage or other problems related to diabetes.

Does Medicare Cover Cataract Surgery?

Yes, Medicare generally covers cataract surgery, which is a common surgical procedure to remove the clouded lens from the eye and replace them with an intraocular lens. Medicare Part B covers the surgical procedure, including the necessary anesthesia, operating room costs, and post-operative care.

There may be certain limitations on the type of artificial lens that is covered or other requirements such as a minimum level of visual impairment. Medicare Part B helps pay corrective lenses, including one pair of glasses as part of your cataract care.

Does Medicare Cover Glaucoma Tests and Treatment?

Yes, Medicare generally covers glaucoma tests and treatment. Medicare Part B covers comprehensive eye exams once every 12 months for people with high-risk factors for glaucoma, including those with diabetes, a family history of glaucoma, people age 65 or over, and Hispanic, or African American individuals over the age of 50.

Medicare also covers certain diagnostic tests such as tonometry, which measures the pressure inside the eye, and ophthalmoscopy, which allows the eye doctor to examine the optic nerve.

If glaucoma is diagnosed, Medicare also covers medically necessary treatments, including eye drops, oral medications, laser therapy, and surgery.

Does Medicare Cover Macular Degeneration?

Age related Macular degeneration is a disease. As a general rule, Medicare covers eye care treatment and diagnosis related to disease or injury.

Medicare Part B covers a comprehensive eye exam once every 12 months for people at high risk for macular degeneration, including those with a family history of the condition, individuals over the age of 65, and those with a history of smoking.

If macular degeneration is diagnosed, Medicare also covers medically necessary treatments, such as injections of medication into the eye, photodynamic therapy, or laser surgery.

Does Medicare Cover Routine Vision Exams?

No, Medicare doesn’t cover routine eye exams for eyeglasses or contact lenses needed to correct vision. Medicare Part B only covers vision exams that are deemed medically necessary to diagnose or treat a specific eye condition or disease, like cataract surgery.

However, some Medicare Advantage plans may offer additional vision benefits, such as coverage for routine eye exams, eyeglasses, or contacts. Make sure to review the specific benefits and costs of your Medicare Advantage plan to understand what vision services are covered.

Medicare Advantage Plan benefits differ from plan to plan and change annually.

Does Medicare Cover Prescription Eyeglasses for Seniors?

Medicare generally does not cover eyeglasses or prescription eye drops for seniors unless they are deemed medically necessary due to a covered eye condition or disease.

However, if a senior has had cataract surgery that implants an intraocular lens, Medicare may cover one pair of eyeglasses or corrective lenses after it. The eyeglasses or contact lenses must be prescribed by a licensed eye doctor who accepts Medicare and must be purchased from a supplier who accepts assignment, which means they agree to accept the Medicare-approved amount as full payment.

Does Medicare Cover Eye Exams for Eye Injuries?

Yes, Medicare does cover eye exams for eye injuries that require medical attention. Medicare Part B covers medically necessary services and supplies needed to diagnose and treat medical conditions, including eye injuries.

Does Medicare Cover Eyeglasses and Contact Lenses?

Medicare generally does not cover the cost of eyeglasses or contacts, with a few exceptions.

If you have had cataract surgery, Medicare Part B may cover one pair of eyeglasses or corrective lenses after the surgery.

Medicare may cover the cost of eyeglasses or contact lenses if they are deemed medically necessary due to another covered eye condition or disease, such as diabetic retinopathy, glaucoma, or macular degeneration. But they must be purchased from a supplier who agrees to accept the Medicare-approved amount as full payment.

Does Medicare Cover Prosthetic Eyes?

Yes, Medicare covers a prosthetic or artificial eye and follow-up polishing and resurfacing of the eye 2 times a year. Prosthetics are considered “durable equipment” and covered under Part B of Original Medicare.

Please beware that prosthetics must be ordered by a doctor and provided to you by a Medicare-participating supplier.

What Is The General Cost of Eyecare Services with Medicare?

Generally, Part B covers 80% of the cost of medically necessary eye care services, such as eye exams, diagnostic tests, and treatments for high-risk eye diseases or injuries.

You pay 20% of allowable charges after you meet your Part B deductible. You may be charged a copay if you get tested in a hospital outpatient setting.

What is Medicare Advantage Vision Coverage?

Most Medicare Advantage plans offer some vision coverage. But each Medicare Advantage plan offers different benefits. It’s also important to note those benefits change every year. One year your coverage can be great, the next year it can be gone.

The best way to add vision coverage to your Original Medicare is to purchase low cost vision coverage.

Private Vision Coverage

Private vision coverage covers corrective vision care and exams. In addition, it can come bundled with dental care not covered by Medicare, all at a very low cost.

Your private coverage is yours. It can’t be taken away from you or the benefits changed like the benefits included with Medicare Advantage plans.

Do Medicare Supplement Plans Cover Vision Care?

Medicare supplement plans pay the copays, coinsurance and deductibles left as the Medicare beneficiaries financial responsibility. A supplement does not cover benefits like eye exams or routine vision care not covered by Medicare.

If Medicare covers eye exams, the supplement will pay its portion to reduce your total cost.  However, if it’s not Medicare-approved, the supplement can’t cover any of the cost. You become responsible for all the charges.

How We Can Help You

As independent Medicare insurance brokers we can help you find the right Medicare coverage for your needs and budget.

If you need or desire to include additional benefits like vision, dental or hearing and more, we can help with that as well. There are many different plans offered, depending on your state. Plus, we can help you add the coverage any day of the year, before or after you start Medicare.