Medicare covers eye exams and some treatments from an ophthalmologist, but not routine glasses or contacts

Medicare Part B covers an eye exam by an ophthalmologist (a medical doctor who treats eye disease) once every 12 months if you have diabetes or a history of glaucoma. For other conditions, Medicare covers the exam only if your doctor refers you for a specific medical reason — not for a routine vision check. The exam itself is covered at 80 percent after you meet your Part B deductible, meaning you pay 20 percent of the approved amount.

Medicare also covers certain eye treatments and procedures when medically necessary: cataract surgery, glaucoma treatment, diabetic retinopathy care, and macular degeneration treatment. It does not cover eyeglasses, contact lenses, or routine refraction (the test to determine your prescription). If you need glasses after cataract surgery, Medicare covers one pair of glasses or contact lenses within a set time frame after the procedure.

Key Takeaways

  • Medicare Part B covers one eye exam per year if you have diabetes or glaucoma, or a single exam if your doctor refers you for a specific eye problem.
  • You pay 20 percent of the approved cost for the exam after meeting your Part B deductible; the ophthalmologist must accept Medicare assignment for this rate to explore.
  • Medicare covers medically necessary treatments like cataract surgery, glaucoma procedures, and retinal disease care, but not routine glasses or contact lenses.
  • One pair of eyeglasses or contact lenses is covered after cataract surgery if obtained within a certain window after the procedure.
  • Vision plans through Medigap or Medicare Advantage may cover routine eye exams and glasses, depending on the specific plan.

When Medicare Part B covers an eye exam

Medicare Part B covers a comprehensive eye exam by an ophthalmologist in two situations. The first is if you have been diagnosed with diabetes or glaucoma — in those cases, you can have one exam covered every 12 months. The second is if your primary care doctor or another physician refers you to an ophthalmologist because of a specific eye problem: sudden vision loss, eye pain, flashes of light, or a suspected cataract, for example.

The exam must be performed by an ophthalmologist (M.D. or D.O.) to be covered. Optometrists (O.D.) are not covered under Part B for routine exams, though some states allow optometrists to diagnose and treat certain eye conditions, and those services may be covered if medically necessary. Check with your ophthalmologist's office to confirm they accept Medicare assignment, which means they agree to accept Medicare's approved amount as full payment (except for your 20 percent coinsurance).

What you pay for an ophthalmologist visit

After you meet your Part B deductible for the year, you pay 20 percent of the Medicare-approved amount for the eye exam. The approved amount varies by location and the complexity of the exam. If the ophthalmologist accepts Medicare assignment, they cannot bill you more than this 20 percent coinsurance. If they do not accept assignment, you may owe more, so confirm this before your appointment.

If you have not yet met your Part B deductible, you pay the full approved amount until the deductible is satisfied, then 20 percent after that. The Part B deductible is the same across all services — once you meet it with any Part B service, it applies to all remaining Part B services for that year.

Eye treatments and procedures Medicare covers

Medicare Part B covers medically necessary eye treatments and surgical procedures. Cataract surgery is covered in full (you pay 20 percent of the approved amount after your deductible). Glaucoma treatment — including eye drops, laser procedures, and surgery — is covered when medically necessary. Diabetic retinopathy care, including laser treatment and injections, is covered. Age-related macular degeneration treatment is covered if it meets medical necessity criteria.

Retinal detachment repair, corneal transplant, and treatment of eye infections are also covered. The key requirement is that the treatment must be ordered by a physician for a diagnosed medical condition, not for cosmetic reasons or routine vision correction. If you are unsure whether a specific procedure is covered, ask your ophthalmologist to contact Medicare before the procedure, or call Medicare directly at 1-800-MEDICARE.

What Medicare does not cover for your eyes

Medicare Part B does not cover routine eye exams for the purpose of getting a new glasses prescription. It does not cover eyeglasses, contact lenses, or the refraction test used to determine your prescription strength. It does not cover eye exams by an optometrist unless the optometrist is treating a specific medical condition that they are licensed to treat in your state.

Cosmetic eye procedures — such as surgery to correct drooping eyelids for appearance only, rather than for vision obstruction — are not covered. Refractive surgery like LASIK is not covered. Routine preventive eye exams for people without diabetes, glaucoma, or a specific eye problem are not covered.

Eyeglasses after cataract surgery

If you have cataract surgery covered by Medicare, you are may have access to to one pair of eyeglasses or contact lenses to correct your vision after the surgery. This must be obtained within a set time frame after the procedure — typically within 30 days of the removal of the surgical bandage or contact lens. The glasses or contacts must be prescribed by the ophthalmologist who performed the surgery.

Medicare covers 80 percent of the approved amount for the glasses or contacts (you pay 20 percent after your deductible). You must obtain them from a supplier that accepts Medicare assignment. If you want a second pair of glasses or more expensive frames, you pay the difference out of pocket. After this one pair is covered, routine glasses are your responsibility.

Vision coverage through Medigap and Medicare Advantage

Original Medicare (Part A and Part B) does not cover routine eye exams or glasses. However, some Medigap plans and many Medicare Advantage plans include vision benefits. Medigap plans do not standardly include vision coverage, but a few insurers offer vision riders you can add for an extra premium. Medicare Advantage plans vary widely — some include routine eye exams, glasses, and contact lenses, while others cover nothing beyond what Original Medicare covers.

If you are enrolled in a Medicare Advantage plan, check your plan documents or call the plan to learn what vision services are included. If you have Original Medicare and want vision coverage, you can purchase a standalone vision insurance plan from a private insurer, though these are not subsidized and you pay the full premium yourself. Compare what each plan covers and what you would pay out of pocket for the services you use most often.

Frequently Asked Questions

Does Medicare cover an eye exam just to update my glasses prescription?

No. Medicare Part B covers an eye exam only if you have diabetes or glaucoma (once per year), or if your doctor refers you for a specific eye problem. A routine exam to get a new glasses prescription is not covered. If you need glasses, you pay for the exam and the glasses yourself, or through a vision plan if you have one.

What is the difference between an ophthalmologist and an optometrist for Medicare coverage?

An ophthalmologist is a medical doctor (M.D. or D.O.) and their medically necessary exams and treatments are covered by Medicare Part B. An optometrist (O.D.) is not typically covered under Part B for routine exams. Some states allow optometrists to diagnose and treat certain eye conditions, and those services may be covered if medically necessary — ask your provider whether they are enrolled in Medicare.

If I have cataract surgery, does Medicare pay for the surgery and the glasses after?

Yes. Medicare covers the cataract surgery itself at 80 percent of the approved amount after your deductible. It also covers one pair of eyeglasses or contact lenses prescribed after the surgery, obtained within 30 days of the surgical bandage removal, at 80 percent of the approved amount. Any additional glasses or more expensive frames are your responsibility.

Can I use my Medicare to see an optometrist instead of an ophthalmologist?

Original Medicare Part B does not cover routine exams by optometrists. However, if an optometrist is licensed in your state to diagnose and treat eye disease, and they are enrolled in Medicare, their medically necessary services may be covered. Call the optometrist's office to confirm they accept Medicare and that the service you need is covered.

Do I need a referral from my doctor to see an ophthalmologist?

Not always. If you have diabetes or glaucoma, Medicare covers your annual eye exam without a referral. If you do not have these conditions, your primary care doctor or another physician must refer you for a specific eye problem for the exam to be covered. You can call an ophthalmologist's office directly — they can tell you whether your situation qualifies for coverage.