Yes. Medicare Part B covers an eye exam for diabetic retinopathy once a year if you have diabetes and the exam is performed by an eye doctor who is legally allowed to do the test in your state.
What Medicare covers
Original Medicare covers a diabetic eye exam under Part B when the purpose is checking for diabetic retinopathy. This is different from a routine vision exam for glasses or contact lenses.
| Service | Original Medicare coverage | What you may pay |
|---|---|---|
| Eye exam for diabetic retinopathy | Covered by Part B once a year if you have diabetes | After the Part B deductible, 20% of the Medicare-approved amount for the doctor's services; in a hospital outpatient setting, a copayment may also apply |
| Routine eye exam for glasses or contact lenses | Not covered by Original Medicare | You pay the full cost unless other coverage applies |
Who is eligible
Medicare.gov says you must have diabetes to qualify for this covered exam. The exam also has to be done by an eye doctor who is legally authorized to perform the test in your state.
How often Medicare pays
Medicare covers this exam once a year. If your provider suggests more frequent eye services, that does not automatically mean Medicare will pay for them. Ask whether the additional service is covered before you schedule it.
What your costs may look like
Under Original Medicare, Part B cost-sharing applies. After you meet the Part B deductible, you generally pay 20% of the Medicare-approved amount for the doctor's services. If the exam takes place in a hospital outpatient setting, you may also owe a copayment.
Your exact out-of-pocket cost can vary based on factors such as whether the doctor accepts assignment, where the service is provided, and whether you have other insurance.
Important exceptions and limits
- This coverage is for an eye exam related to diabetic retinopathy, not a general routine vision exam.
- Getting the exam from an eligible eye doctor matters for coverage.
- Medicare may not cover services that are recommended more often than Medicare's coverage rules allow.
How to verify coverage before the appointment
- Confirm that the visit is being scheduled as a covered diabetic eye exam for diabetic retinopathy.
- Ask whether the eye doctor is legally allowed to perform the test in your state.
- Check whether the doctor accepts Medicare assignment.
- Ask whether the exam will be done in a doctor's office or hospital outpatient setting, since costs can differ.
- If you have other insurance, ask how it coordinates with Medicare.
Related coverage questions
- Medicare Vision Coverage: Eye Exams, Glasses and Costs
- Does Medicare Cover Eyeglasses or Contact Lenses?
- How Medicare Part B covers cataract surgery