Medicare's coverage of eye care is split between two parts, and glasses are covered only in specific situations

Medicare Part B covers eye exams if you have diabetes or a history of glaucoma, and it covers the exam itself at no cost after you meet your deductible. For routine eye exams — the kind you get to check if you need new glasses — Medicare does not pay. Medicare does not cover glasses or contact lenses except in one narrow case: after cataract surgery, Medicare will pay for one pair of glasses or contact lenses (including the fitting) within a set timeframe.

If you need glasses for everyday vision correction, you pay the full cost yourself. Many seniors find it cheaper to buy frames and lenses through a discount retailer or online than through a traditional eye doctor's office. Some Medicare Advantage plans (Part C) do cover routine eye exams and glasses, so if you have that type of plan, check your coverage documents or call the plan directly.

Key Takeaways

  • Medicare Part B covers eye exams only if you have diabetes or glaucoma, not for routine vision checks.
  • Medicare does not pay for glasses, contact lenses, or the eye exam needed to prescribe them, except after cataract surgery.
  • After cataract surgery, Medicare covers one pair of glasses or contact lenses and the fitting within a specific window.
  • Some Medicare Advantage plans include coverage for routine eye exams and glasses — check your plan documents or call your plan.
  • You can use your glasses prescription at any retailer, including online vendors, to find lower prices than an eye doctor's office.

When Medicare Part B pays for an eye exam

Medicare Part B covers an eye exam performed by an ophthalmologist or optometrist if you have been diagnosed with diabetes or glaucoma. The exam must be to monitor or diagnose these conditions, not to check your vision for glasses. You pay nothing for the exam itself after you have met your Part B deductible for the year.

If you have diabetes, you should have a dilated eye exam at least once a year to check for diabetic retinopathy, a condition that can cause vision loss. Medicare covers this exam as a preventive service. If you have glaucoma or a family history of glaucoma, your doctor may recommend regular monitoring exams, and Medicare will cover those too.

These exams do not include a refraction — the test that determines your glasses prescription. If the eye doctor performs a refraction during the visit, Medicare will not pay for that portion, and you will receive a bill for it.

Glasses and contact lenses: what Medicare does and does not cover

Medicare does not cover the cost of glasses, contact lenses, or the eye exam needed to write a glasses prescription. This applies to all seniors on Original Medicare (Part A and Part B), regardless of age or income. If you need new glasses, you pay the entire cost out of pocket.

The one exception is after cataract surgery. If you have a cataract removed, Medicare Part B will pay for one pair of glasses or contact lenses (including the fitting) within a set timeframe after surgery — usually within a few weeks. Your eye surgeon will tell you when you are may be able to access to order them. After that window closes, any additional glasses or contact lenses are your responsibility.

You do not have to buy glasses from your eye doctor's office. Once you have a valid prescription, you can take it to any retailer — a chain like Warby Parker or Zenni, a local optician, or a big-box store like Costco. Prices vary widely, so it is worth comparing a few places before you buy.

Medicare Advantage plans and eye coverage

If you are enrolled in a Medicare Advantage plan (also called Part C), your coverage for eye exams and glasses depends on the specific plan you chose. Some Medicare Advantage plans include coverage for routine eye exams and glasses; others do not. A few plans cover only the exam, not the glasses.

To find out what your plan covers, check the Summary of Benefits and Coverage document that came with your plan materials, or call the plan's customer service number (on the back of your insurance card). Ask specifically whether routine eye exams and glasses are covered, what the copay or coinsurance is, and whether you have to use an in-network eye doctor.

If your Medicare Advantage plan does cover glasses, you may still find better prices by using your prescription at a discount retailer. Compare the plan's copay against the full cost of glasses elsewhere before you decide where to buy.

How to get a glasses prescription without paying for an exam

If you do not have diabetes or glaucoma and need a glasses prescription, you will have to pay for the eye exam yourself. However, you have options for keeping the cost down. Some community health centers and vision clinics offer low-cost or sliding-scale eye exams based on income. Call your local health department or search for "low-cost eye exam near me" to find centers in your area.

Retailers like Costco, Sam's Club, and Walmart have optometrists on staff who perform eye exams at lower prices than many independent eye doctors. You do not have to be a member to use the eye care department at some of these locations. Once you have a prescription, you can buy glasses anywhere — you are not required to buy from the same place where you got the exam.

Some online retailers offer virtual eye exams using your smartphone camera, though these work only if you already have a recent prescription and just need to update it. They do not replace a full in-person exam if you have not had one in several years.

What happens after cataract surgery

Cataract surgery changes how your eye focuses light, so most people need new glasses afterward. Medicare Part B covers one pair of glasses or contact lenses (including the fitting) after cataract surgery. Your eye surgeon will tell you when your eye has healed enough to measure for glasses — usually two to four weeks after surgery.

You can order your glasses through your surgeon's office, or you can take your prescription to any other retailer. Medicare will pay the same amount regardless of where you buy them, so compare prices first. The coverage includes frames, lenses, and the fitting, but only one pair per eye per surgery.

If you need a second pair of glasses or bifocals after the initial pair, you pay for those yourself. If you have Medicare Advantage, check your plan documents to see whether it covers additional glasses after cataract surgery.

Questions to ask your eye doctor or Medicare plan

Before you schedule an eye exam or order glasses, it helps to know what you will and will not have to pay for. Here are the key questions to ask.

If you have Original Medicare and see an eye doctor: "Will Medicare pay for this exam, or will I owe the full cost?" and "If you perform a refraction, will you bill that separately to me?" If you have a Medicare Advantage plan: "Does my plan cover routine eye exams and glasses?" and "Do I have to use an in-network provider, or can I see any eye doctor?"

If you are having cataract surgery: "When can I order my glasses, and what does Medicare cover?" and "Can I take my prescription to another retailer, or do I have to order through your office?"

Frequently Asked Questions

Does Medicare cover bifocals or progressive lenses?

No, Medicare does not cover bifocals or progressive lenses as a separate benefit. If you need them after cataract surgery, Medicare covers one pair of glasses with any type of lens, but you may pay extra out of pocket if you choose a premium lens option like progressives. Ask the optician what the base cost is and what the upgrade will cost you.

Can I use my vision insurance along with Medicare?

Yes, if you have a separate vision insurance plan (sometimes called a vision discount plan), you can use it for glasses and routine eye exams. Medicare and vision insurance work separately — vision insurance pays its share, and you pay any remaining balance. Check your vision plan documents to see what it covers.

What if I have both Original Medicare and a Medicare Advantage plan?

You cannot have both at the same time. If you are enrolled in a Medicare Advantage plan, that is your primary coverage, and Original Medicare is not active. If you want to switch back to Original Medicare, you have to disenroll from your Medicare Advantage plan first, usually during the annual open enrollment period.

Does Medicare cover eye surgery for conditions other than cataracts?

Medicare Part B covers eye surgery for cataracts, glaucoma, and some other conditions that affect vision. It does not cover elective surgery like LASIK or refractive surgery to correct nearsightedness. If you are unsure whether a specific procedure is covered, ask your eye doctor to check with Medicare before scheduling.

Can I get a glasses prescription from my regular doctor instead of an eye doctor?

Your primary care doctor cannot write a glasses prescription — only an ophthalmologist or optometrist can. If you need a prescription, you have to see an eye care professional. Some community health centers have optometrists on staff who charge less than private practices.