Medicare covers some eye care, but not routine eye exams

Original Medicare (Parts A and B) does not cover routine eye exams — the kind you get to check if you need glasses or contacts. However, Medicare does cover eye exams and treatment if you have certain eye diseases, and it covers one pair of glasses or contact lenses after cataract surgery. If you have diabetic retinopathy, glaucoma, age-related macular degeneration, or cataracts, your eye care is covered.

Medicare Advantage plans (Part C) sometimes cover routine eye exams and eyeglasses as an added benefit, but coverage varies by plan. You need to check your specific plan's details to know what is included.

Key Takeaways

  • Original Medicare covers eye exams and treatment for eye diseases like glaucoma and diabetic retinopathy, but not routine exams for vision correction.
  • Medicare covers one pair of glasses or contact lenses after cataract surgery, but not routine eyeglasses or contact lenses.
  • Medicare Advantage plans may add routine eye exam and eyeglass coverage, so you should review your plan documents to see what yours includes.
  • An ophthalmologist (eye doctor with an MD or DO degree) is covered under Medicare, but an optometrist may not be, depending on the service.

What Original Medicare covers for eye care

Original Medicare covers an eye exam if you have symptoms of an eye disease or a diagnosis that needs monitoring. If your doctor refers you to an ophthalmologist because you have glaucoma, diabetic retinopathy, or macular degeneration, that visit and any testing are covered at 80 percent after you meet your Part B deductible. The ophthalmologist must be enrolled in Medicare for the visit to be covered.

Medicare also covers treatment for these conditions — laser surgery, injections, or other procedures — when medically necessary. If you have cataracts, the surgery is covered, and Medicare will pay for one pair of eyeglasses or contact lenses after the surgery to help you see while you heal.

Routine eye exams to check your vision and prescribe glasses are not covered. Neither are eyeglasses, contact lenses, or eye exams for the purpose of fitting them, unless they follow cataract surgery.

How Medicare Advantage plans handle eye coverage

Many Medicare Advantage plans include routine eye exams and eyeglass coverage as an added benefit. Some plans cover one eye exam per year and a set dollar amount toward frames and lenses — for example, $150 toward eyeglasses or $0 copay for an exam. Other plans cover nothing beyond what Original Medicare covers.

The coverage details change from year to year and vary widely between plans and insurers. You can find what your plan covers by looking at your plan's Summary of Benefits and Coverage document, which your plan sends each fall during open enrollment. You can also call the plan's customer service number on the back of your insurance card and ask specifically what routine eye exams and eyeglasses cost under your plan.

The difference between an ophthalmologist and an optometrist

An ophthalmologist is a medical doctor (MD or DO) who specializes in eye care. They can perform eye exams, prescribe glasses, diagnose and treat eye diseases, and perform eye surgery. Medicare covers ophthalmologists for medically necessary care.

An optometrist is not a medical doctor but is trained to perform eye exams and prescribe glasses and contact lenses. Some optometrists can also diagnose and treat certain eye conditions, depending on their state's laws. Medicare coverage of optometrists is limited — Original Medicare typically covers an optometrist only if they are treating a specific eye disease that Medicare covers, not for routine exams. Medicare Advantage plans may cover optometrists for routine exams, but you need to check your plan.

What to do if you need glasses but do not have coverage

If you are on Original Medicare and need an eye exam for vision correction, you will pay out of pocket. A routine eye exam at a private optometrist or ophthalmologist typically costs between $100 and $300, depending on where you live and what testing is included. Eyeglasses usually cost $200 to $500 for frames and lenses, though prices vary widely.

Some communities have low-cost vision clinics or programs run by nonprofit organizations that offer discounted eye exams and glasses to seniors with limited income. You can search for these through your local health department or by calling 211, which connects you to local health and human services programs. Some Costco and Walmart locations also offer lower-cost eye exams and eyeglasses than independent optometrists.

When to see an eye doctor even without coverage

You should see an eye doctor right away if you experience sudden vision loss, eye pain, flashing lights, new floaters, or a shadow moving across your vision. These can be signs of serious eye conditions like retinal detachment or acute glaucoma that need when ready treatment. Go to an emergency room or urgent care if you cannot reach your eye doctor.

You should also see an eye doctor if you have diabetes, even if you have no vision problems. Diabetes can damage blood vessels in the eye without causing symptoms you notice. Medicare covers an annual dilated eye exam for people with diabetes to check for diabetic retinopathy, so this visit is covered under Original Medicare.

Questions to ask your doctor or insurance plan

Before you schedule an eye exam, call your Medicare plan or your doctor's office and ask: "Is this eye exam covered under my plan, and if so, what is my copay or coinsurance?" If you are on Original Medicare and your doctor is referring you for an eye exam, ask your doctor whether the exam is for a medical reason (which Medicare covers) or for vision correction (which it does not).

If you are on a Medicare Advantage plan, ask your plan whether the eye doctor you want to see is in network, because out-of-network care may cost more or not be covered at all. Also ask whether you need a referral from your primary care doctor before you schedule the appointment.

Frequently Asked Questions

Does Medicare cover glasses after cataract surgery?

Yes. Medicare covers one pair of eyeglasses or contact lenses after cataract surgery to help you see while your eye heals. The glasses must be prescribed by the surgeon and obtained within a certain time frame after surgery — usually within a few weeks. You pay 20 percent coinsurance after your Part B deductible.

Does Medicare cover blue light glasses or special lens coatings?

No. Medicare covers standard eyeglasses or contact lenses only after cataract surgery. Special coatings, blue light lenses, or progressive lenses are not covered and would be an out-of-pocket cost if you choose them.

Can I use my Medicare Advantage vision benefit at any eye doctor?

Most Medicare Advantage plans have a network of eye doctors you must use to receive coverage. If you see an out-of-network doctor, you may pay more or get no coverage at all. Check your plan documents or call your plan to confirm the eye doctor is in network before you schedule.

What if I have both Original Medicare and a Medigap plan — does Medigap cover eye exams?

No. Medigap plans do not cover routine eye exams or eyeglasses. Medigap covers some of the costs that Original Medicare does not pay (like coinsurance and deductibles), but it does not add new benefits like vision coverage.

Does Medicare cover contact lenses instead of glasses?

Medicare covers contact lenses only after cataract surgery, as an alternative to glasses. For routine vision correction, contact lenses are not covered under Original Medicare or most Medicare Advantage plans.