Does Medicare Cover Diabetic Eye Exams?

The short answer is yes – Original Medicare does cover diabetic eye exams. Diabetes can cause changes to the blood vessels in your retina. If these changes are not monitored and treated promptly, you could be at high risk of permanent damage or vision loss. Medicare and other health insurance plans cover regular eye exams for those beneficiaries with diabetes to encourage blindness prevention.

How Does Medicare Cover Diabetic Eye Exams?

Medicare Part B provides coverage for an annual eye exam for people with diabetes to detect diabetic retinopathy. The eye exam must be administered by an eye doctor authorized by law to operate in your state.

  • You are responsible for your annual Part B deductible and 20% coinsurance of the Medicare-approved amount for any medical services your doctor provides.
  • In a hospital outpatient facility, you must pay a copayment.

What Type of Eye Exam Is Covered?

One diabetic eye exam per year is covered. This test is known as a dilated eye exam, where your eye doctor will put drops in your eyes to dilate (enlarge) your pupils.

They will then look at the back of your eye to check for any signs of eye disease or damage. This exam aims to catch eye conditions early and start treatment immediately to prevent further damage.

Bottom Line

Routine vision care and eye exams are essential to managing diabetes, maintaining health, and preventing long-term complications. Fortunately, Original Medicare will cover diabetic eye exams once a year.

Ask your doctor or healthcare provider any questions or concerns regarding your diabetic eye care.

Sources: Medicare.govMedicare.orgAARP


Mark Prip

Since 2003, Mark Prip has been leading  Policy Guide, Inc., providing knowledgeable information about Medicare, life insurance, and dental coverage to clients in over forty states. With his unparalleled hands-on experience aiding countless Medicare beneficiaries in selecting an appropriate health plan, he is a prime example amongst other competitors for expertise and assistance. Mark has held his Florida Health & Life Insurance License (E051889) since 2003. View his license profile on the Florida Department of Insurance website.