What Medicare Covers for Eye Care and Optometry

Medicare covers some eye care, but not routine optometry visits

Medicare Part B covers eye exams only when they are medically necessary — that is, when a doctor needs to check your eyes because of a disease or condition like diabetes, glaucoma, or age-related macular degeneration. It does not cover routine eye exams done to check your vision for glasses or contacts. If you need an eye doctor to diagnose or treat an eye disease, Medicare will pay for that visit. If you want an exam to see whether you need new glasses, you pay the full cost yourself.

The distinction matters because many people assume Medicare covers all medical care. It does not. The program draws a line between treating disease and maintaining general health. An optometrist or ophthalmologist can perform both kinds of exams in the same office, but Medicare only pays for one.

Key Takeaways

Medicare Part B covers eye exams and treatment for eye diseases like glaucoma, cataracts, and diabetic retinopathy, but not routine vision checks for glasses or contacts.
You pay 20 percent of the cost for covered eye exams and treatments after you meet your Part B deductible, and the doctor must accept Medicare.
Medicare covers cataract surgery and the cost of one pair of glasses or contact lenses after cataract surgery, but not routine eyeglasses or contact lenses.
Medigap and Medicare Advantage plans may cover routine eye exams and eyeglasses, so check your plan documents or call your plan to learn what is included.
If you have diabetes or a family history of glaucoma, ask your primary care doctor for a referral to an eye doctor who accepts Medicare.

What Medicare Part B covers for eye care

Medicare Part B pays for eye exams when an eye doctor needs to diagnose or monitor a disease. Common covered conditions include glaucoma, cataracts, diabetic retinopathy (damage to the blood vessels in the retina from diabetes), age-related macular degeneration, and dry eye disease. If you have any of these conditions or symptoms like blurred vision, eye pain, or flashing lights, an exam to investigate is covered.

Treatment for these conditions is also covered. That includes laser surgery for glaucoma, injections into the eye for macular degeneration, and prescription eye drops. If you need cataract surgery, Medicare Part B covers the procedure and the surgeon's fee. After surgery, Medicare also covers one pair of glasses or contact lenses (your choice) to correct your vision, but only once per eye, per lifetime.

You pay 20 percent of the Medicare-approved amount for covered services after you meet your Part B deductible, which is $240 in 2024. The eye doctor must accept Medicare assignment (agree to the Medicare fee) for this cost-sharing to explore. If the doctor does not accept assignment, you may owe more.

What Medicare does not cover

Medicare Part B does not cover routine eye exams — exams done to check whether you need glasses or contacts when there is no disease present. It also does not cover eyeglasses or contact lenses for everyday vision correction, even if you have worn them for years. Sunglasses, even prescription sunglasses, are not covered. Vision therapy and orthoptics (exercises to improve eye alignment) are not covered unless they are part of treatment for a covered eye disease.

If you want an eye exam to update your prescription, you will need to pay out of pocket. The cost varies by location and provider, but a routine eye exam typically costs between $100 and $300. Eyeglasses usually cost $200 to $500 or more, depending on the frames and lenses you choose.

How Medigap and Medicare Advantage plans may help

Some Medigap (supplemental insurance) plans and Medicare Advantage plans include coverage for routine eye exams and eyeglasses. Medigap plans are sold by private insurers and supplement what Medicare Part B covers; they do not replace it. A few Medigap plans offer a small benefit toward routine eye care, though the amount is usually modest — often $50 to $200 per year toward exams or glasses.

Medicare Advantage plans (Part C) are an alternative to Original Medicare. Many Advantage plans include vision benefits as part of their coverage. Some offer a routine eye exam once per year at no cost or a low copay, and some include an allowance toward eyeglasses or contacts. The benefits vary widely by plan and by region, so you need to check your specific plan's details.

To find out what your plan covers, look at your plan documents (the Summary of Benefits or Evidence of Coverage) or call the plan's customer service number on the back of your card. Do not assume your plan covers vision — ask directly.

How to find an eye doctor who accepts Medicare

Not all optometrists and ophthalmologists accept Medicare. Before you schedule an appointment, call the office and ask whether the doctor accepts Medicare assignment. If they do, you will pay only your 20 percent coinsurance after the deductible. If they do not accept assignment, ask what they charge and whether you can get a refund from Medicare if you pay upfront.

You can search for Medicare-accepting eye doctors on the Medicare.gov provider search tool. Go to Medicare.gov, click "Care Providers," and search by your location and specialty (optometry or ophthalmology). The search will show you doctors in your area and whether they accept Medicare. You can also call your primary care doctor's office and ask for a referral to an eye doctor who accepts Medicare.

When to see an eye doctor for a covered exam

If you have diabetes, you should have a dilated eye exam at least once per year to check for diabetic retinopathy, even if your vision feels fine. This exam is covered by Medicare. If you have a family history of glaucoma or have been told you have high eye pressure, ask your doctor about a glaucoma screening. If you notice sudden changes in your vision, eye pain, flashing lights, or new floaters (spots that drift across your vision), contact an eye doctor right away — these can be signs of a serious condition that needs urgent care.

Age alone does not make an eye exam medically necessary in Medicare's view, but many eye diseases become more common with age. If you are over 65 and have not had an eye exam in several years, it is reasonable to ask your primary care doctor whether a screening exam would be appropriate for you.

The difference between optometrists and ophthalmologists

Both optometrists and ophthalmologists can perform eye exams and prescribe glasses and contacts. The main difference is training and scope of practice. Optometrists complete a four-year Doctor of Optometry degree and can diagnose and treat many eye diseases, prescribe medications, and fit contact lenses. Ophthalmologists are medical doctors (MDs or DOs) who complete medical school and a four-year residency in eye care; they can perform surgery and manage complex eye diseases.

For Medicare purposes, it does not matter which type of doctor you see — both can bill Medicare for covered services. If you need cataract surgery or treatment for a serious eye disease, an ophthalmologist may be more appropriate, but your primary care doctor or optometrist can refer you if needed.

Frequently Asked Questions

Will Medicare pay for my eye exam if I have diabetes?

Yes. If you have diabetes, a dilated eye exam to check for diabetic retinopathy is a covered service under Medicare Part B. You pay 20 percent of the cost after your deductible. The exam must be done by an eye doctor (optometrist or ophthalmologist) who accepts Medicare.

Does Medicare cover the cost of new glasses after cataract surgery?

Yes, but only one pair per eye, per lifetime. After cataract surgery, Medicare Part B covers one pair of glasses or contact lenses (you choose) to correct your vision with the new lens implant. You pay 20 percent of the cost after your deductible. Additional glasses or contacts are not covered.

What if my eye doctor does not accept Medicare?

You can still see the doctor, but you will likely pay the full cost upfront. Ask the office what they charge and whether you can submit a claim to Medicare yourself for reimbursement. Some doctors who do not accept assignment will refund you the difference between their charge and the Medicare-approved amount if you request it.

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

No. Most Medicare Advantage plans have a network of eye doctors you must use to receive the benefit. Check your plan documents or call your plan to find in-network providers. If you see an out-of-network doctor, you may pay more or receive no benefit at all.

Does Medicare cover contact lenses?

Medicare covers one pair of contact lenses (or glasses — you choose) after cataract surgery. For routine vision correction, contact lenses are not covered. Some Medicare Advantage plans include a contact lens benefit, so check your plan details.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.