Medicare copayments for optometrists have not changed uniformly across all plans, but your out-of-pocket costs depend on which Medicare coverage you have and what service you receive.
Medicare Part B covers eye exams for certain conditions — diabetic retinopathy, glaucoma, and age-related macular degeneration — but not routine vision exams. If you see an optometrist for one of those covered conditions, you typically pay 20 percent of the Medicare-approved amount after you meet your Part B deductible. If you see an optometrist for a routine eye exam or to get glasses, Medicare does not cover it at all, and you pay the full cost the optometrist charges.
Costs vary by region and by provider. An optometrist in a rural area may charge less than one in a city. Some optometrists accept Medicare assignment (meaning they accept Medicare's approved amount as full payment), while others do not. If your optometrist does not accept assignment, you may owe more than the standard 20 percent.
If you have a Medicare Advantage plan (Part C), your copayment for an eye exam or eye care visit may be different — some plans cover routine eye exams or offer vision benefits that Original Medicare does not. You should check your plan's summary of benefits or call the plan directly to learn what your specific copayment is.
Key Takeaways
- Medicare Part B covers eye exams only for specific eye diseases (diabetic retinopathy, glaucoma, age-related macular degeneration), not routine vision exams.
- For covered eye exams under Part B, you pay 20 percent of the Medicare-approved amount after meeting your deductible.
- Routine eye exams and vision correction (glasses, contacts) are not covered by Original Medicare and you pay the full cost.
- Medicare Advantage plans may offer different copayments or cover routine eye exams, so you need to check your individual plan's benefits.
- If your optometrist does not accept Medicare assignment, you may owe more than the standard 20 percent copayment.
What Medicare Part B Actually Covers for Eye Care
Original Medicare Part B covers an eye exam only when it is medically necessary to diagnose or treat a specific eye disease. The three conditions Medicare recognizes are diabetic retinopathy (damage to blood vessels in the retina from diabetes), glaucoma (increased pressure in the eye that damages the optic nerve), and age-related macular degeneration (deterioration of the central part of the retina). If you have one of these conditions and your doctor refers you to an optometrist or ophthalmologist for an exam, Medicare will cover part of the cost.
A routine eye exam — the kind you get to check your vision and update your glasses prescription — is not covered by Part B. Neither is the cost of eyeglasses, contact lenses, or most eye surgery for vision correction. If you want a routine eye exam, you pay the optometrist's full fee out of pocket, or you can purchase a separate vision insurance plan.
How Your Copayment Works Under Part B
When you have a covered eye exam under Part B, you are responsible for 20 percent of the Medicare-approved amount. Before that copayment applies, you must first meet your Part B deductible for the year. In 2024, the Part B deductible is $240, but this amount can change annually. Once you have paid $240 in Part B services, Medicare begins to cover 80 percent of approved charges, and you pay the remaining 20 percent.
The Medicare-approved amount is not the same as what the optometrist charges. Medicare sets an approved amount for each service in each geographic area. If your optometrist accepts Medicare assignment, they agree to accept the approved amount as full payment (except for your 20 percent copayment). If they do not accept assignment, they can charge more, and you may owe the difference between the approved amount and their actual charge.
To find out whether your optometrist accepts Medicare assignment, ask them directly or check the Medicare provider search tool on Medicare.gov. Knowing this before your visit helps you understand what you will owe.
Medicare Advantage Plans and Vision Coverage
If you have a Medicare Advantage plan (also called Part C), your coverage for eye care may be different from Original Medicare. Some Medicare Advantage plans include routine eye exams as a covered benefit, and some offer vision benefits like discounts on glasses or contact lenses. Others may have a copayment for an eye exam that is lower or higher than the 20 percent you would pay under Part B.
The vision benefits in Medicare Advantage plans vary widely. One plan might cover a routine eye exam once per year with a $15 copayment, while another plan might not cover routine exams at all. You need to check your specific plan's summary of benefits or call the plan's customer service number to learn what your copayment is and what services are covered.
If you are thinking about switching to a Medicare Advantage plan or are comparing plans during open enrollment, vision coverage is worth considering, especially if you need regular eye care.
What Has Changed and What Stays the Same
Medicare's rules about what eye care it covers have remained stable for many years. Part B still covers exams for the same three eye diseases, and the 20 percent copayment structure has not changed. However, the actual dollar amount you pay depends on the Medicare-approved amount in your area, which can shift slightly from year to year.
The Part B deductible does increase most years. In recent years it has gone up by small amounts — from $233 in 2022 to $240 in 2024. This means that if you have multiple Part B services in a year, you may reach your deductible sooner than you did in previous years.
If you have a Medicare Advantage plan, your plan's copayments and covered benefits can change from year to year. Your plan is required to send you a notice of changes in the fall, before the new year begins. Reading that notice carefully helps you understand whether your eye care costs will change.
How to Find Out What You Will Pay
The most direct way to learn your copayment is to contact your optometrist's office before your appointment. Tell them you have Medicare (and whether it is Original Medicare or a specific Medicare Advantage plan) and ask what you will owe for the visit. They can tell you whether they accept Medicare assignment and what your copayment will be.
You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask about coverage for a specific service or to confirm your deductible status. Have your Medicare card handy when you call.
If you have a Medicare Advantage plan, call the plan's customer service number (on the back of your insurance card) to ask about vision benefits and copayments. Plans are required to tell you what your out-of-pocket costs will be for a specific service.
Frequently Asked Questions
Does Medicare cover the cost of glasses or contact lenses?
No. Original Medicare does not cover eyeglasses, contact lenses, or the exam to fit them. Some Medicare Advantage plans offer vision benefits that include discounts on glasses or contacts, but you need to check your specific plan. You can also purchase a separate vision insurance plan if you want coverage for glasses or contacts.
If I have diabetes, does Medicare automatically cover my eye exams?
Medicare covers an eye exam for diabetic retinopathy only if you have been diagnosed with that condition and your doctor refers you for an exam. Having diabetes alone does not automatically mean your routine eye exams are covered. You would need to see your eye care provider and have them document that you have diabetic retinopathy for Medicare to cover the exam.
What if my optometrist charges more than Medicare's approved amount?
If your optometrist accepts Medicare assignment, they cannot charge you more than your 20 percent copayment (after your deductible). If they do not accept assignment, they can charge more, and you may owe the difference. Always ask whether your optometrist accepts Medicare assignment before your visit.
Can I use my Medigap plan to help pay my eye care copayment?
Some Medigap plans cover the 20 percent copayment you owe for Part B services, including covered eye exams. Check your Medigap plan's summary of benefits or call your Medigap insurance company to see whether your plan covers this copayment.