Medicare Part A and Part B do not cover routine eye exams or glasses

Original Medicare — Part A and Part B together — will not pay for a standard eye exam to check your vision or update your prescription. Part A covers hospital inpatient care, and Part B covers doctor visits and outpatient services, but neither includes preventive eye exams or eyeglasses as a benefit.

Part B does cover eye care in specific medical situations: if you have diabetes, glaucoma, age-related macular degeneration, or cataracts, your doctor can order tests and treatments that Part B will pay for. It also covers cataract surgery and the surgeon's fee. But a routine checkup to see if you need new glasses is not included.

If you want coverage for eye exams and frames, you will need to look beyond Original Medicare. That means either a Medicare Advantage plan that includes vision, a standalone vision plan, or paying out of pocket.

Key Takeaways

  • Original Medicare Part A and Part B do not cover routine eye exams, glasses, or contact lenses.
  • Part B does cover eye care related to specific diseases like diabetes, glaucoma, and cataracts, as well as cataract surgery.
  • Medicare Advantage plans often include vision coverage, though the amount and the copay vary by plan.
  • Standalone vision plans and discount vision programs are available to Original Medicare users who want exam and glasses coverage.
  • You can change to a plan with vision coverage during the Annual Enrollment Period (October 15 to December 7 each year) or if you may have access to for a Special Enrollment Period.

What Part B covers for eye conditions

Part B will pay for eye exams and tests if they are ordered to diagnose or manage a medical eye disease. This includes dilated eye exams for diabetic retinopathy screening, visual field tests for glaucoma, optical coherence tomography (OCT) scans for macular degeneration, and tonometry (eye pressure measurement). The exam must be performed by an ophthalmologist or optometrist enrolled in Medicare.

Part B also covers the full cost of cataract surgery, including the surgeon's fee and facility charges. If you choose an intraocular lens implant during cataract surgery, Part B covers a standard lens; if you want a premium lens for astigmatism or distance vision, you pay the difference yourself.

Diabetic eye exams are particularly important: Part B covers one dilated eye exam per year for people with diabetes, performed by an ophthalmologist or optometrist. This is separate from a routine vision check and is considered preventive care for a chronic condition.

Medicare Advantage plans and vision coverage

Many Medicare Advantage plans (Part C) include vision coverage as an added benefit. The coverage varies widely: some plans cover an eye exam once per year, others every two years. Some include a set dollar amount toward glasses or contacts (often $100 to $200 per year), and some cover a pair of glasses or contacts but not both.

Copays for eye exams under Medicare Advantage typically range from $0 to $50, depending on the plan. Copays for glasses or contacts also vary. You will need to check your specific plan's coverage details, which are listed in the plan's Summary of Benefits and Coverage document, available on Medicare.gov or from the plan directly.

Not all Medicare Advantage plans include vision, so if vision coverage matters to you, search for plans in your area that offer it. You can compare plans on Medicare.gov using the Plan Finder tool, which lets you filter by vision benefits.

Standalone vision plans for Original Medicare users

If you have Original Medicare and want vision coverage, you can buy a standalone vision plan from companies like VSP Vision Care, EyeMed, or Aetna Vision. These are separate from Medicare and are not subsidized by it, so you pay the full premium yourself.

A typical standalone plan costs $100 to $200 per year and usually covers one eye exam per year (with a small copay, often $10 to $25) and a set amount toward frames and lenses or contacts. Some plans cover 100 percent of the exam and a portion of frames; others use a copay system. Read the plan details carefully, because coverage limits differ.

Discount vision programs like GoodRx Vision or BenefitHub also exist and do not require membership fees. Instead, you pay a discounted rate at participating optometrists and eyeglass retailers. These are not insurance but can reduce the cost of exams and glasses if you do not have coverage.

How to switch to a plan with vision coverage

If you are on Original Medicare and want to move to a Medicare Advantage plan with vision benefits, you can do so during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect January 1 of the following year.

If you have a may have access to life event — such as loss of other health coverage, a move to a new service area, or marriage — you may be able to change plans outside the Annual Enrollment Period through a Special Enrollment Period. Contact Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

If you are already in a Medicare Advantage plan and want to switch to a different plan with better vision coverage, you can also do so during the Annual Enrollment Period. You can also switch back to Original Medicare during this window, though you would then need to purchase a standalone vision plan separately.

Out-of-pocket costs for eye care without coverage

Without vision coverage, a routine eye exam typically costs $100 to $300, depending on your location and whether the optometrist or ophthalmologist is in a major city or rural area. A basic pair of eyeglasses costs $150 to $400 for frames and lenses combined, though designer frames or specialty lenses (progressive, high-index, or blue-light blocking) can cost more.

Contact lenses cost $150 to $300 per year for a year's supply, plus the cost of the fitting exam if you have never worn them. If you need cataract surgery and do not have coverage, the cost is typically $3,000 to $4,000 per eye, though this varies by region and facility.

Many optometry offices and eyeglass retailers offer discounts for uninsured patients or payment plans. It is worth asking whether your provider offers a cash discount or whether you can spread the cost over several months.

Special situations: Medicaid and vision coverage

If you are may be able to access for both Medicare and Medicaid (called "dual may be able to access"), Medicaid may cover vision services that Medicare does not. Medicaid vision coverage varies by state: some states cover routine eye exams and glasses, others cover only medical eye care. Contact your state Medicaid office to learn what your state covers.

If you receive Supplemental Security Income (SSI) or have a low income, you may also be may be able to access for programs like EyeCare America, which provides free or low-cost eye exams and glasses to uninsured and underinsured seniors. You can learn more through your local Area Agency on Aging or by calling 1-800-222-EYES.

Frequently Asked Questions

Does Medicare cover the cost of glasses or contact lenses?

Original Medicare Part A and Part B do not cover glasses or contact lenses. Medicare Advantage plans may include a set dollar amount per year (often $100 to $200), but coverage varies by plan. Standalone vision plans purchased separately may also cover frames and lenses.

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

Yes. Part B covers one dilated eye exam per year for people with diabetes, performed by an ophthalmologist or optometrist. This is considered preventive care for a chronic condition and is separate from a routine vision check.

Can I switch to a Medicare Advantage plan with vision benefits right now?

You can switch during the Annual Enrollment Period (October 15 to December 7 each year), with changes taking effect January 1. If you have a may have access to life event, such as loss of other coverage or a move, you may be able to switch outside this window through a Special Enrollment Period. Call 1-800-MEDICARE to ask.

What happens if I need cataract surgery?

Part B covers the full cost of cataract surgery, including the surgeon's fee and facility charges. It also covers a standard intraocular lens implant. If you choose a premium lens, you pay the difference yourself.

Are there low-cost eye exam options if I cannot afford vision coverage?

Yes. EyeCare America offers free or low-cost exams and glasses to uninsured and underinsured seniors. Discount vision programs like GoodRx Vision offer reduced rates at participating providers. Many optometry offices also offer cash discounts or payment plans for uninsured patients.