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Will Medicare Pay For Eye Exams

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Original Medicare Vision Coverage

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Original Medicare also covers limited vision care. It does not cover routine eye exams for contact lenses or glasses.

However, Medicare Part B will cover some preventive or diagnostic eye exams, including glaucoma tests, yearly eye exams to test for diabetic retinopathy and eye tests for macular degeneration.

Medicare will typically cover cataract surgery to implant an intraocular lens if its performed with traditional surgical techniques or with lasers.

Following the procedure, Medicare Part B will typically provide some coverage for corrective lenses. The coverage for corrective lenses under these circumstances is limited to one pair of eyeglasses with standard frames or one set of contact lenses.

Medicare also covers eye prostheses for patients with an absence or shrinkage of an eye due to a birth defect, trauma or surgical removal. Coverage includes polishing and replacements every five years.

If you need vision coverage for routine services, you may want enroll in a Medicare Advantage plan that includes that benefit.

When Does Medicare Cover Eye Exams

Original Medicare does not cover routine eye exams. For most regular eye health checkups, you will have to pay 100% out of pocket or buy additional coverage.Medicare.gov, Eye exams , Accessed November 3, 2021

Thankfully, Medicare Part B does cover certain exams for age-related eye problems. Glasses, while important, are not as urgent as a glaucoma exam, and Medicare accounts for these specific needs as we age.Medicare.gov, Eye exams , Accessed November 3, 2021

Medicare covers eye exams and, in some cases, surgery for these conditions:

Find A Medicare Advantage Plan That Covers Dental And Vision Care

Medicare Advantage plans can come in a variety of types, such as HMOs or PPOs.

The type of plan you have may affect which dental or vision providers you can visit in your plan network. Before enrolling in a plan, its wise to check the plans network participants to see if your favorite dentist or optometrist accepts the plan.

Compare Medicare Advantage plans in your area

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

1 Fugelsten Biniek, J. et al. . Medicare Advantage 2021 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2021-spotlight-first-look.

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.

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What Does Medicare Cover For Vision

Original Medicare will not cover the cost of eyeglasses, contact lenses or routine vision exams.

Medicare Advantage Plans, on the other hand, are health plans run by private insurance companies and combine the benefits of Medicares Hospital and Medical Insurance . Plus, they include additional benefits like Medicare Prescription Drug Coverage as well as services like routine eye exams and costs like eyeglasses, often for an extra premium.

While Medicare Advantage Plans cost a little more than Original Medicare, theyre worth considering as enrollment may still be cheaper than paying out of pocket for vision care.

In addition to annual vision exams, these vision benefits may include:

  • Preventive eye exams

  • Eyeglasses

  • Contact lenses

Please note that specific benefits may vary depending on the plans available in your area. For help selecting an individual health plan that includes vision benefits, visit the official website for Medicare.

SEE ALSO: Does Medicare cover eye exams?

How Much Does An Eye Exam Cost Without Insurance

Does Medicare Pay For Eye Exams

For individuals without insurance, the average cost of an eye exam depends on the eye test, location and the type of eye doctor you choose to visit in your area. Combining national averages from FAIR Health and VSP, you can expect to pay: $171-$200 is the average cost of an eye exam without insurance

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How To Get Your Eye Exams Covered By Medicare

If you know you have vision needs that are difficult to pay for on your own, you may want to search for a Medicare Advantage plan that includes vision coverage beyond what Original Medicare offers. If you find one you like, you can join the plan when youre newly eligible for Medicare at age 65, or during Medicare Open Enrollment .

If you already have a Medicare Advantage plan but want to switch to one with better vision coverage, you can do that during Medicare Advantage Open Enrollment .

Still not sure about your Medicare coverage for eye exams or any other health-care needs? Check with a licensed Medicare expert first at to weigh your options.

How Can You Get Your Routine Eye Exams Paid For By Medicare

If none of the special circumstances above apply to you, don’t give up yet. It’s still possible for you to obtain Medicare coverage that will pay for routine vision care.

A Medicare Advantage plan is an alternative way of getting your Medicare benefits. These are healthcare plans that are offered by Medicare-approved private companies, and they take the place of Medicare A and B if you choose to enroll in one of them.

Medicare Advantage plans offer a variety of additional benefits that are not covered under Original Medicare. Vision, dental, wellness and hearing services are offered in many of these plans.

Extra items such as adult daycare services, transportation to medical visits, and over-the-counter medications also may be included. Medicare Part D, which covers prescription medication, is also usually incorporated into these plans.

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Unlike Original Medicare, which is accepted almost everywhere, Medical Advantage plans usually have a local network of preferred providers. Like many employer health plans, they may not cover services that are out of network, or they may cover a smaller portion of out-of-network services. They may also have certain rules for referrals and other services, so be sure you understand what is required of you under the plan.

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Does Medicare Pay For Eye Exams Glasses And Other Vision Coverage

Key Takeaways:
  • Original Medicare generally does not cover vision care
  • Most Medicare Advantage and Medicare Supplement plans offer coverage for vision-related expenses, including eye exams and glasses
  • While Medicare Advantage and Medicare Supplement plans offer a base level of coverage, you can get more expenses paid for by adding a Medicare Part D prescription drug plan
  • There are certain times of the year to enroll in these plans. Plan carefully to get the best insurance offer

Routine vision care is an important factor to take into account when choosing a Medicare plan. This is because not all parts of Medicare cover services like eye exams, glasses, and other vision-related costs.

In this guide, we will outline the parts of Medicare that do and do not cover vision care. We will also discuss the different types of exams and screenings covered, the average Medicare copay involved, and the enrollment options available for people looking into this type of coverage.

How Much Does Medicare Cost

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The cost of Medicare depends on what you need.

Original Medicare is the cheapest option. Medicare Part A, which covers hospital services, typically has no monthly payment if you paid taxes to Medicare for a specific period. Most people get free Medicare Part A.

Medicare Part B covers outpatient services this is what usually covers Medicare-approved vision services. Part B has a deductible of $203 per benefit period . Additionally, monthly payments must be met .

Once your deductible is met, Medicare Part B covers 80% of approved health services. Youll have very affordable prices for most treatments and services.

The price of Medicare Advantage is difficult to estimate before you sign up for a plan. Youll at least have the same monthly payment as Medicare Part B . However, the price of Medicare Advantage can vary depending on the coverage.

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Who Accepts Medicare For An Eye Exam

No eye care center will accept Original Medicare for a routine eye exam because Original Medicare does not cover eye exams. Because of this, you will be responsible for 100% of the cost of an eye exam.

If you have a Medicare Advantage plan that covers vision, the providers who accept your coverage will depend on your plans network and your location. Its wise to talk with your insurance agent to discover what local practices are in your network.

Hearing Exams And Hearing Aids

Medicare doesnt cover routine hearing exams, hearing aids, or exams for fitting hearing aids. Medicare Part B covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment. All people with Part B are covered.

Your costs in Original Medicare:

  • You pay 100% for routine exams and hearing aids.
  • You pay 20% of the Medicare-approved amount for the doctors services for covered exams, and the Part B deductible applies.
  • In a hospital outpatient setting, you also pay the hospital a copayment.

Note: Some Medicare Advantage plans offer extra hearing benefits. Be sure to contact the plan for more information.

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Eye Exams For Individuals With Glaucoma And Diabetes

If youre at risk for glaucoma or diabetes, Medicare Part B can cover annual eye exams once every 12 months. For instance, if you use Medicare Part B for glaucoma eye exams, 80 percent of the exam will be covered. However, youd still be responsible for paying the remaining 20 percent of the Medicare-approved amount after youve met your Part B deductible.

Medicare Coverage For Glaucoma Tests

Does Medicare Pay For Eye Exams

If you’re at high risk for glaucoma, Part B covers a glaucoma test once every 12 months.

You’re considered to be at high risk if at least one of the following applies:

  • You have diabetes
  • You have a family history of glaucoma
  • You’re African American and age 50 or older
  • You’re Hispanic and age 65 or older

It’s important to note this test is only covered if it’s performed by an eye doctor who is legally allowed to do the test in your state. You pay 20% of the Medicare-approved amount for this exam, and the Part B deductible applies.

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Medicare Advantage Vision Coverage

A Medicare Advantage plan with vision benefits may cover things like:

  • Routine eye exams
  • Eyeglasses and contact lenses
  • Upgraded frames

Some Medicare Advantage plans may even offer coverage for specific retailers, such as frames from Warby Parker.

Check with your plan carrier to learn more about the terms of your Medicare Advantage plan vision coverage.

Does Medicare Pay For Vision

Medicare Part B vision benefits

Medicare Part B covers some vision care, but not routine vision exams. You are not covered for vision correction such as eyeglasses or contact lenses under Medicare Part B unless you need vision correction after cataract surgery. Medicare Part B also does not cover eye refractions.

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How Much Does A Diabetic Eye Exam Cost

The glaucoma eye exam cost can run about $100 to $150, unless you have health insurance. Diabetes sometimes causes damage to the small blood vessels in your retina, eventually leading to blindness if left untreated, states the National Institutes of Health. This type of eye disease is called diabetic retinopathy.

Are There Other Options To Get Medicare Coverage For Eye Exam Costs

Is VISION covered by Medicare?

You may be able to enroll in a Medicare Advantage plan that offers coverage for routine eye exam costs and even prescription eyewear. The Medicare Advantage program is an alternative way to get your Original Medicare benefits. These plans must provide the same coverage as Part A and Part B .

Many Medicare Advantage plans include coverage for prescription drugs, as well as other benefits to help you manage your health-care costs, such as:

  • Benefits for routine vision care, including an annual eye exam and prescription eyewear
  • Coverage for routine hearing care
  • Optional dental care coverage for routine exams, cleanings, and even restorations and dentures
  • Benefits for wellness programs and discounted gym memberships

Not all Medicare Advantage plans have all these optional benefits and coverage, and not all plans may be available in all areas. You must continue to pay your Part B premium, plus any additional premium required by your plan, and premiums may vary depending on the plan you choose and where you live. You will also be responsible for any copayments, coinsurance amounts, or deductibles required by your plan.

Request an email or schedule a telephone call by using one of the links at the bottom of the page. To see a list of plans in your area you may qualify for, click the Compare Plans button on this page.

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Do Medicare Supplement Plans Cover Eye Exams

Medicare Supplement plans help pay your out-of-pocket costs under Part A and Part B. If Medicare covers a service, its also covered by your Medicare Supplement plan. If its not covered by Part A or Part B, it wont be covered by Medigap.

In other words, Medicare Supplement plans cover eye exams only in the situations listed above.

Dont count on your supplement plan to pick up the difference between Medicare-approved frames and an upgraded pair of eyeglasses. Medigap plans generally pay only your share of the Medicare-approved amount for an item or service. For example, if Medicare allows $100 for a pair of glasses and you choose a pair that costs $125, your Medicare Supplement plan will only pay 20 percent of the allowable charges . Youre still on the hook for the difference.

Medicare Coverage For Diabetic Eyecare

If you have diabetes, some eyecare may be covered by Part B. Specifically, eye exams for diabetic retinopathy are covered once per year.

However, eyeglasses are not covered unless you’ve had a vitrectomy or cataract surgery, in which case Part B would cover the cost of one pair of glasses or contact lenses.

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Will Medicare Pay For Treatment For A Detached Retina

A detached retina can cause permanent vision loss if not treated quickly. Medicare will cover surgery to repair a detached retina, but youll be responsible for your Part B deductible and 20% coinsurance, which Medigap can help take care of. Depending on where you have your procedure, a copayment might apply as well. Similarly, Medicare Advantage will cover retina surgery to preserve vision, although your out-of-pocket costs will depend on your plan.

What Parts Of Medicare Include Coverage For Glasses And Eye Exams

Does Medicare Pay For Eye Exams?

Original Medicare does not cover eye care services. However, there are some exceptions for certain diagnostic tests and treatments.

The good news is that both Medicare Advantage and Medicare Supplement plans do cover vision exams, eyeglasses, and contact lenses to some extent. Specific coverage varies depending on your insurance carrier and the plan you choose, as some Medicare insurance providers offer more benefits than others.

Below is a detailed breakdown of how the different parts of Medicare apply vision coverage:

While private Medicare insurance carriers are required by law to provide at least the same base level of coverage offered by Medicare Part A and Part B, not all offer vision coverage as additional benefits.

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Does Medicare Cover Vision And Dental

Original Medicare does not cover routine dental or vision care. There are certain circumstances under which Original Medicare may provide some coverage for dental or vision care in an emergency setting or as part of surgery preparation.

However, you may be able to receive routine dental and vision coverage by enrolling in a Medicare Advantage plan that includes dental and vision benefits.

Original Medicare: Minimal Coverage

Original Medicare does not cover eye exams, eyeglasses, or contacts. Under an Original Medicare plan, you would have to pay for all of the associated costs related to these services.

However, there are a few exceptions. Medicare Part B does pay for some routine diagnostic tests and treatment for patients with certain risks or eye conditions, such as:

  • Annual eye exams for diabetes patients: The patient pays 20% of the Medicare-approved cost of the treatment or service.
  • Annual glaucoma tests for at-risk populations: The patient pays 20% of the cost.
  • Age-related macular degeneration tests and treatment: The patient pays 20% of the cost.
  • Corrective lenses for post-cataract surgery implant and intraocular lenses: The patient pays 20% of the cost issued from a Medicare-enrolled supplier.

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How Often Does Medicare Pay For An Eye Exam

Original Medicare will not cover contact lenses, eyeglasses or an eye exam, unless the exam is to diagnose or treat certain conditions. But Medicare Advantage, depending on which plan you have, can provide vision coverage.

Heres where things can get confusing, so bear with us

Medicare Advantage has various plan options that cover different things. There are six plans, but the most commonly used are:

Health Maintenance Organization plans have a limited network of providers in which patients typically have to get care. The only exceptions are with emergency care, urgent care and dialysis.

Preferred Provider Organization plans have a network of preferred medical professionals and specialists. Patients can see providers outside the PPO network, but its more expensive.

Because Medicare Advantage is provided by private insurance companies, the frequency that eye exams are covered may vary. An insurance agent with experience in Medicare can give you more information on the different plans and packages available.

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