Original Medicare covers certain medically necessary eye services, but generally does not cover routine vision care such as eye exams for glasses or contact lenses, and it does not usually cover eyeglasses or contacts. However, Medicare Part B does cover some important vision-related services, including yearly diabetic eye exams for eligible people and one pair of standard eyeglasses or one set of contact lenses after each covered cataract surgery with an intraocular lens.
Quick answer: what Medicare covers for vision
| Vision service | Original Medicare coverage | What you may pay |
|---|---|---|
| Routine eye exam for glasses or contacts | Not covered | You pay all costs |
| Eye exam for diabetic retinopathy if you have diabetes | Covered by Part B once a year | After the Part B deductible, 20% of the Medicare-approved amount; a hospital outpatient copayment may also apply |
| Most eyeglasses or contact lenses | Usually not covered | You usually pay all costs |
| One pair of standard eyeglasses or one set of contact lenses after each covered cataract surgery with an intraocular lens | Covered by Part B | After the Part B deductible, 20% of the Medicare-approved amount; you pay extra for upgraded frames |
What Original Medicare usually does not cover
Original Medicare does not cover routine eye exams for eyeglasses or contact lenses. If your visit is only for a routine vision prescription or refraction, you should expect that Original Medicare will generally not pay for it.
Original Medicare also does not usually cover eyeglasses or contact lenses. In most situations, that means you are responsible for the full cost unless you have other coverage.
Vision services Part B can cover
Yearly diabetic eye exams
Part B covers eye exams for diabetic retinopathy once a year if you have diabetes and meet Medicare’s eligibility rules. The exam must be provided by an eye doctor who is legally allowed to perform the test in your state.
For this covered exam, you generally pay the Part B deductible first, then 20% of the Medicare-approved amount for the doctor’s services. If the exam is done in a hospital outpatient setting, a copayment may also apply.
Glasses or contacts after covered cataract surgery
There is an important exception to Medicare’s usual rule on eyewear. After each covered cataract surgery that implants an intraocular lens, Part B covers one pair of eyeglasses with standard frames or one set of contact lenses.
After you meet the Part B deductible, you generally pay 20% of the Medicare-approved amount for these corrective lenses. If you choose upgraded frames, you pay the added cost for that upgrade.
Medicare payment also depends on where you get the glasses or contacts. Medicare will only pay when the supplier participates in Medicare.
What about cataract surgery itself?
Medicare Part B may cover cataract surgery that implants conventional intraocular lenses, depending on where you live. Costs for the surgery can vary based on the setting and other factors, so it is important to confirm both the surgery coverage and the post-surgery eyewear rules separately.
Could a Medicare Advantage plan include more vision benefits?
Possibly. Some Medicare Advantage plans offer extra benefits that Original Medicare does not cover, including vision benefits. Those benefits are plan-specific, so you should check your plan materials or contact the plan directly for details about routine exams, glasses, contacts, and cost-sharing.
Checklist: how to verify your vision coverage
- Identify the exact service: routine exam, diabetic eye exam, cataract surgery, glasses, or contact lenses.
- Ask whether the service is covered by Original Medicare or by your Medicare Advantage plan, if you have one.
- If the service is a diabetic eye exam, confirm that you have diabetes and that the eye doctor is legally allowed to perform the test in your state.
- If you need glasses or contacts after cataract surgery, confirm that the cataract surgery is covered and that the supplier participates in Medicare.
- Ask where the service will be provided, because hospital outpatient settings can involve additional copayments.
- Request an estimate of your deductible, coinsurance, and any non-covered charges before the appointment or order.
FAQ
Does Medicare cover routine eye exams?
Original Medicare does not cover routine eye exams for eyeglasses or contact lenses.
Does Medicare cover eyeglasses?
Usually not. A key exception is one pair of standard eyeglasses after each covered cataract surgery that implants an intraocular lens.
Does Medicare cover contact lenses?
Usually not. A key exception is one set of contact lenses after each covered cataract surgery that implants an intraocular lens.
Does Medicare cover diabetic eye exams every year?
Yes, Part B covers an eye exam for diabetic retinopathy once a year for eligible people with diabetes.
Glaucoma screening is another covered service
Part B covers screening once every 12 months for people at high risk: those with diabetes, a family history of glaucoma, African Americans age 50 or older, or Hispanic adults age 65 or older. An eye doctor legally authorized in your state must perform or supervise it. The Part B deductible and 20% coinsurance apply; an outpatient hospital copayment may also apply.