Does Medicare Cover Eye Exams?

No, Original Medicare (Parts A and B) does NOT cover eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses.

Eye exams and other vision-related costs are generally not covered by Original Medicare (Part A and Part B). However, there are some exceptions when Medicare will cover eye exams.

Qualifying Medical Conditions for Eye Exams

If you have a medical-related eye condition such as cataracts, glaucoma, macular degeneration, and diabetic retinopathy, then Medicare Part B may cover your eye exam.

You can get a comprehensive annual eye exam with your Medicare coverage if you have a qualifying medical condition. The eye exam will typically include various tests, such as a vision exam for visual acuity, eye muscle function, and glaucoma screening. Medicare may cover further diagnostic tests and treatments if your doctor detects any medical condition.

Eye Exams for At-Risk Medical Conditions

In addition to medical conditions that affect eyesight, Medicare may cover eye exams for preventive health screenings. A few examples are:

• You are at risk of developing a medical condition, such as diabetes or high blood pressure
• You have a family history of glaucoma
• You’re African American and age 50 or older
• You’re Hispanic and age 65 or older

In these scenarios, your doctor or healthcare professional could order an eye exam, and Medicare may cover the cost. This is only applicable if the eye exam is part of a covered preventive health screening.

How Can I Get Coverage for Eye Exams?

• Consider purchasing stand-alone vision insurance or a combination dental/vision/hearing (DVH) plan.
• Some Medicare Advantage plans (Part C) offer routine vision benefits as an additional coverage option.
• Inquire with your current private insurance provider about any available vision care discount programs you may qualify for.
• Compare your current vision coverage options with other insurance companies.
• Consult your eye doctor regarding any eye care discount programs available to you.

Bottom Line

In summary, Medicare only covers eye exams under certain circumstances. If you have a medical condition affecting your eyes or are at risk of developing one, Medicare may cover your eye exam cost. However, routine eye exams for eyeglasses or contact lenses are not covered by Original Medicare. You should check your specific health insurance plan coverage to find out if it covers vision care or offers additional vision services, and if so, what copays, coinsurance, or out-of-pocket costs would apply. Taking care of your eye health is essential, so discuss all your options with your doctor and insurance provider to ensure you get proper care with maximum coverage.

Article resources: Routine Eye Exams With Medicare | Medicare & Vision Care

FAQ's

• What is vision insurance?

  Vision insurance is a type of health insurance that helps cover the cost of vision care, such as eye exams and eyeglasses. It can also help pay for contact lenses, laser vision correction surgery, and even certain prescription drugs that treat eye conditions. Vision insurance usually covers routine vision exams, corrective lenses, and discounts on frames or contact lenses.

• What type of insurance do you need for eye glasses?

  You will need a type of health insurance that covers the expenses of eye exams, eyeglasses, and contact lenses wholly or partially. This is beneficial because such items can get expensive over time.