Medicare Part B does not cover routine eye exams, glasses, or contact lenses

Medicare Part B covers some vision-related services, but not the ones most people think of first. Part B will pay for eye exams and treatment if you have certain eye diseases — diabetic retinopathy, glaucoma, age-related macular degeneration, or cataracts. It will also cover the surgery to remove a cataract and the intraocular lens implant that replaces it. But Part B does not cover the cost of eyeglasses, contact lenses, or routine eye exams done just to check your vision and update your prescription.

The distinction matters because many people assume Medicare covers vision care the way it covers other medical care. It does not. If you need glasses or contacts for everyday seeing, you are paying out of pocket unless you have a separate vision plan through a Medicare Advantage plan, a retiree health plan from a former employer, or a standalone vision insurance policy.

The one exception is after cataract surgery. Medicare Part B will pay for one pair of eyeglasses or one set of contact lenses in the month after your surgery, but only if the surgery was done at a Medicare-approved facility. After that month, any new glasses or contacts are your responsibility.

Key Takeaways

  • Medicare Part B covers treatment and surgery for cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration, but not routine eye exams or corrective lenses.
  • Routine eye exams to check your vision and update your prescription are not covered by Original Medicare, even if performed by an ophthalmologist.
  • You get one pair of eyeglasses or one set of contact lenses covered by Part B in the month after cataract surgery, then you pay for replacements yourself.
  • Medicare Advantage plans often include vision coverage as an added benefit, so check your plan's details if you are enrolled in one.
  • Standalone vision insurance or a retiree health plan from a former employer are common ways to cover glasses, contacts, and routine eye care.

What Part B covers: eye diseases and surgical treatment

Part B covers the diagnosis and treatment of specific eye conditions. If you have diabetic retinopathy — damage to the blood vessels in your retina caused by diabetes — Part B will cover the eye exam that detects it, the imaging tests used to monitor it, and any laser surgery or injections needed to treat it. The same applies to glaucoma, where pressure inside the eye damages the optic nerve. Part B covers the tonometry test that measures eye pressure, the imaging that checks for nerve damage, and the medications or surgery used to lower pressure.

For age-related macular degeneration (AMD), Part B covers the eye exam, imaging tests like optical coherence tomography (OCT), and injections into the eye if you have the wet form of the disease. For cataracts, Part B covers the surgery to remove the clouded lens and the intraocular lens implant that replaces it. It also covers the pre-surgery eye exam and measurements needed to determine the right lens power for your eye.

In all these cases, you must see an ophthalmologist or optometrist who accepts Medicare, and the condition must be documented as a medical problem, not just a vision correction need. Part B typically covers 80 percent of the cost after you have met your deductible for the year.

What Part B does not cover: routine vision care

A routine eye exam — the kind where you read letters on a chart and the doctor asks "better one or two" — is not covered by Part B. This is true even if an ophthalmologist performs it and even if you have never had an eye disease. Medicare considers this a refractive exam, meaning it is done to measure your need for glasses or contacts, not to diagnose or treat a disease.

Eyeglasses and contact lenses are also not covered, with the single exception of one pair of glasses or one set of contacts in the month after cataract surgery. If you need a new prescription because your vision has changed, or if your current glasses are damaged or lost, you pay the full cost yourself. This applies whether you buy from an optical shop, an online retailer, or a big-box store.

Refraction services — the tests used to determine your eyeglass or contact lens prescription — are not covered. Neither are progressive lenses, photochromic lenses, or any other specialty lens options. If you want these, you pay out of pocket.

How to find out what your specific plan covers

If you are enrolled in Original Medicare (Part A and Part B), the coverage rules above explore to you. You can call Medicare at 1-800-MEDICARE to confirm what is covered for a specific condition or to find a Medicare-approved eye doctor near you.

If you are enrolled in a Medicare Advantage plan, your coverage may be different. Many Advantage plans include vision benefits as part of their package — typically covering an annual routine eye exam, a discount on glasses or contacts, or both. The details vary widely by plan and by year. You can find your plan's vision coverage in your Summary of Benefits and Coverage document, which was mailed to you when you enrolled. If you cannot find it, call the plan's customer service number on the back of your insurance card.

If you have a retiree health plan from a former employer, that plan may cover vision care. Check your plan documents or call the plan administrator to see what is included.

Vision coverage options outside Medicare

Many people buy standalone vision insurance to cover routine eye exams and glasses. These plans are sold by insurance companies and through membership organizations like AARP. They typically cost $10 to $20 per month and cover one or two eye exams per year, a discount on frames and lenses, and sometimes a set dollar amount toward glasses or contacts. The coverage is modest, but it can offset the cost of an exam and a new pair of glasses.

Some vision plans are sold through discount programs rather than insurance. These are not insurance — they are membership programs that give you a discount at participating optical shops. They cost less than insurance but offer no coverage, only a percentage off the retail price. They can be worth it if you know where you want to buy your glasses.

You can also straightforward pay out of pocket. A routine eye exam typically costs $100 to $200 at an independent optometrist or ophthalmologist, and $50 to $150 at a retail chain like Costco or Walmart. Eyeglasses range from $100 to $500 or more depending on the frames and lenses you choose.

The cataract surgery exception: one pair of glasses covered

After you have cataract surgery at a Medicare-approved facility, Part B will pay for one pair of eyeglasses or one set of contact lenses. This must be ordered in the month after your surgery. The coverage includes the frames and lenses, and Part B pays 80 percent of the approved amount after your deductible.

This benefit exists because cataract surgery changes your vision significantly, and you need new glasses to see clearly afterward. Once that month has passed, any additional glasses or contacts are your responsibility. If you need a new prescription six months later, you pay for it yourself.

To use this benefit, you must have the surgery at a facility that accepts Medicare. Your surgeon's office can tell you whether the facility is Medicare-approved and can help you order your glasses through a Medicare-approved supplier.

Common mistakes to avoid

The biggest mistake is assuming that because Medicare covers some eye care, it covers all eye care. Many people call Medicare expecting to learn that their routine eye exam or new glasses are covered, only to find out they are not. If you need an eye exam for any reason other than monitoring a known eye disease, assume you are paying out of pocket unless you have a separate vision plan.

Another mistake is not checking your Medicare Advantage plan's vision benefits. If you are enrolled in an Advantage plan, you may have coverage you do not know about. Spend 10 minutes reviewing your plan documents or calling customer service to find out what is included.

A third mistake is waiting too long after cataract surgery to order your glasses. The one-pair benefit only applies in the month after surgery. If you wait two months, you lose the benefit. Talk to your surgeon's office about timing before you leave the facility.

Frequently Asked Questions

Will Medicare Part B pay for an eye exam to get a new glasses prescription?

No. Part B does not cover routine eye exams done to check your vision or update your prescription. It only covers eye exams related to diagnosing or monitoring a specific eye disease like glaucoma or diabetic retinopathy. If you need an exam for a new prescription, you pay the full cost yourself.

Does Medicare cover the cost of bifocals or progressive lenses?

No. The only glasses covered by Part B are the one pair you receive in the month after cataract surgery, and that covers basic frames and lenses. Specialty lenses like bifocals, progressive lenses, or photochromic lenses are not covered. You would need a separate vision plan to offset the cost.

If I have a Medicare Advantage plan, am I automatically covered for vision care?

Not automatically. Many Advantage plans include vision benefits, but not all do, and the benefits vary widely. Check your plan's Summary of Benefits and Coverage or call the plan's customer service number to find out exactly what vision services and products are covered under your specific plan.

Can I use my Part B coverage to buy reading glasses?

No. Reading glasses are considered corrective lenses for vision correction, not treatment for an eye disease. Part B does not cover them. The only exception is the one pair of glasses covered in the month after cataract surgery.

What should I do if I cannot afford an eye exam or glasses?

Contact your local health department or a community health center to ask about low-cost or sliding-scale vision services. Some nonprofit organizations also offer free or reduced-cost eye exams and glasses to older adults with limited income. Your area agency on aging can point you toward these programs.